Healthcare Provider Details

I. General information

NPI: 1750497533
Provider Name (Legal Business Name): JENNIFER J JACOBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GLADES RD
BOCA RATON FL
33432-1419
US

IV. Provider business mailing address

PO BOX 862565
ORLANDO FL
32886-2565
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-4400
  • Fax: 561-362-4445
Mailing address:
  • Phone: 800-248-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3259022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: