Provider Demographics
NPI:1932380755
Name:JACOBS, REBECCA ANDERSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANDERSON
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:TOTTEN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 COIT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-596-5821
Mailing Address - Fax:972-596-5634
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-596-5821
Practice Address - Fax:972-596-5634
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01482363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical