Provider Demographics
NPI:1811784879
Name:JACOBS, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:JACOBS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 HILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1900
Mailing Address - Country:US
Mailing Address - Phone:270-925-5487
Mailing Address - Fax:
Practice Address - Street 1:2560 COUNTY ROAD 112
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-0835
Practice Address - Country:US
Practice Address - Phone:866-205-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse