Provider Demographics
NPI:1881314144
Name:JACOBS, BRANDY RENEE' (CSFA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENEE'
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:10545 W CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2495
Mailing Address - Country:US
Mailing Address - Phone:509-552-5641
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:509-552-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty