Provider Demographics
NPI:1457779639
Name:JACOB, ANCY CHAKKALAKAL (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANCY
Middle Name:CHAKKALAKAL
Last Name:JACOB
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W POLST ST. PROFESSIONAL BUILDING, 6 TH FL. # 17
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-864-4395
Mailing Address - Fax:312-864-9500
Practice Address - Street 1:1969 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3765
Practice Address - Country:US
Practice Address - Phone:312-864-4395
Practice Address - Fax:312-864-9500
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011429363LF0000X
IL041-306342163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice