Provider Demographics
NPI:1720784846
Name:JACOBS, ANEISHA B (RN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANEISHA
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 SPOLETO LOOP
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6486
Mailing Address - Country:US
Mailing Address - Phone:678-770-4808
Mailing Address - Fax:
Practice Address - Street 1:1924 CLIFF VALLEY WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2421
Practice Address - Country:US
Practice Address - Phone:404-728-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290215363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health