Provider Demographics
NPI:1295579993
Name:JACOBS, PARKER JADIN CAMERON (MS)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:JADIN CAMERON
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1029
Mailing Address - Country:US
Mailing Address - Phone:727-345-2667
Mailing Address - Fax:727-209-2667
Practice Address - Street 1:8081 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1029
Practice Address - Country:US
Practice Address - Phone:727-345-2667
Practice Address - Fax:727-209-2667
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health