Provider Demographics
NPI:1770589434
Name:JACOBS, REBECCA LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHIPLEY RUN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4714
Mailing Address - Country:US
Mailing Address - Phone:856-258-4241
Mailing Address - Fax:
Practice Address - Street 1:FRANKFORD TORRESDALE HOSPITAL
Practice Address - Street 2:KNIGHTS AND RED LION ROADS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-612-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN511963L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081568Medicare ID - Type Unspecified