Healthcare Provider Details

I. General information

NPI: 1487983433
Provider Name (Legal Business Name): MOLLY JACOBS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD SUITE 101
ARCATA CA
95521-4742
US

IV. Provider business mailing address

670 9TH ST SUITE 203
ARCATA CA
95521-6248
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-1385
  • Fax: 707-825-8203
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22060
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22060
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number22060
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: