Provider Demographics
NPI:1780995456
Name:JACOBS, DANA LEIGH (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LEIGH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6975
Mailing Address - Fax:
Practice Address - Street 1:690 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2344
Practice Address - Country:US
Practice Address - Phone:561-955-2131
Practice Address - Fax:561-955-3755
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60252699207Q00000X
FLME119396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine