Provider Demographics
NPI:1972198653
Name:NAGEL, JACOB (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34355 170TH ST
Mailing Address - Street 2:
Mailing Address - City:DIKE
Mailing Address - State:IA
Mailing Address - Zip Code:50624-8029
Mailing Address - Country:US
Mailing Address - Phone:515-257-0079
Mailing Address - Fax:
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2999
Practice Address - Country:US
Practice Address - Phone:319-352-4120
Practice Address - Fax:319-352-3992
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant