Provider Demographics
NPI:1982685038
Name:JACOB, PATRICIA J (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:JACOB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:MCMICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:100 S MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1479
Mailing Address - Country:US
Mailing Address - Phone:302-659-4490
Mailing Address - Fax:302-659-4495
Practice Address - Street 1:100 S MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1479
Practice Address - Country:US
Practice Address - Phone:302-659-4490
Practice Address - Fax:302-659-4495
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily