MEDICARE: MS. SANDEE MILLER JACOBS APN

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
1	363LA2100X	Acute Care Nurse Practitioner	A03173ANP	AR

General Provider Information

NPI Number	:	1184954034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDEE MILLER JACOBS APN

Provider Business Mailing Address
First Line	:	9101 KANIS RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-224-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 KANIS RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-224-4001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	03/31/2023

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