Provider Demographics
NPI:1013649680
Name:HUNTER, JACOB L (CRNA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:L
Last Name:HUNTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:HUBBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7538 COUNTY ROAD 107
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-9531
Mailing Address - Country:US
Mailing Address - Phone:419-307-5093
Mailing Address - Fax:
Practice Address - Street 1:7538 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-9531
Practice Address - Country:US
Practice Address - Phone:419-307-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10038481367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered