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NPI Code Detail

MEDICARE: NIKKI CHRISTINA JACOBUS

MEDICARE: NIKKI CHRISTINA JACOBUS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramAZ

General Provider Information

NPI Number : 1265365019
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKKI CHRISTINA JACOBUS
Provider Business Mailing Address
First Line : 14994 E AZTEC PL
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-1614
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 650 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ NIKKI CHRISTINA JACOBUS ” Practice Location

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