Provider Demographics
NPI:1396526752
Name:JACOB, NICOLE (FNLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:FNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6273
Mailing Address - Country:US
Mailing Address - Phone:609-238-4172
Mailing Address - Fax:
Practice Address - Street 1:144 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-6273
Practice Address - Country:US
Practice Address - Phone:609-238-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education