Healthcare Provider Details

I. General information

NPI: 1699747808
Provider Name (Legal Business Name): MARGARET MARY JACOBS FNP-PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 HWY 4
ARNOLD CA
95223
US

IV. Provider business mailing address

PO BOX 3308 2518 ASPEN WAY
ARNOLD CA
95223-3308
US

V. Phone/Fax

Practice location:
  • Phone: 209-795-1270
  • Fax:
Mailing address:
  • Phone: 209-768-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number493773
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14787
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF 10304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: