Provider Demographics
NPI:1801172671
Name:JONES, JACOB FARLOW (RN)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:FARLOW
Last Name:JONES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 HOOLAULEA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1444
Mailing Address - Country:US
Mailing Address - Phone:719-510-1547
Mailing Address - Fax:
Practice Address - Street 1:2237 HOOLAULEA ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1444
Practice Address - Country:US
Practice Address - Phone:719-510-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO194729163WC1500X
HI75147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health