Provider Demographics
NPI:1932758216
Name:BARNES, JACOB ALAN
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ALAN
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 BAY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3176
Mailing Address - Country:US
Mailing Address - Phone:757-775-1996
Mailing Address - Fax:
Practice Address - Street 1:3012 BAY SHORE LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3176
Practice Address - Country:US
Practice Address - Phone:757-775-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA218197-702196251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health