Provider Demographics
NPI:1508601634
Name:BARB, JACOB TANNER (RN)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TANNER
Last Name:BARB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:777 WATAUGA RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TN
Mailing Address - Zip Code:37694-3103
Mailing Address - Country:US
Mailing Address - Phone:423-631-9162
Mailing Address - Fax:
Practice Address - Street 1:777 WATAUGA RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TN
Practice Address - Zip Code:37694-3103
Practice Address - Country:US
Practice Address - Phone:423-631-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN255632163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics