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NPI Code Detail

MEDICARE: MRS. EDWINA YVONNE JACOBS FNP

MEDICARE: MRS. EDWINA YVONNE JACOBS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner654339TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP122669OTHERTXAPRN
213293OTHERTXPRESCRIPTIVE AUTHORIZATION
3654339OTHERTXBOARD OF NURSING FAMILY PRACTICE NURSE PRACTITIONER LICENSE

General Provider Information

NPI Number : 1063765451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EDWINA YVONNE JACOBS FNP
Provider Business Mailing Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 888-972-9401
Provider Business Practice Location Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 888-972-9401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2012
Last Update Date : 03/07/2023

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