Provider Demographics
NPI:1205658762
Name:CASHDOLLAR, JACOB AARON
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:AARON
Last Name:CASHDOLLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14048 FENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9151
Mailing Address - Country:US
Mailing Address - Phone:631-816-3626
Mailing Address - Fax:
Practice Address - Street 1:14048 FENWOOD CT
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9151
Practice Address - Country:US
Practice Address - Phone:631-816-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily