Provider Demographics
NPI:1295117208
Name:JACOBS, MICHELLE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4500
Mailing Address - Country:US
Mailing Address - Phone:305-281-1118
Mailing Address - Fax:
Practice Address - Street 1:2971 BIRD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4500
Practice Address - Country:US
Practice Address - Phone:305-281-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist