Healthcare Provider Details

I. General information

NPI: 1619505310
Provider Name (Legal Business Name): JACOB NEARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

V. Phone/Fax

Practice location:
  • Phone: 330-328-6884
  • Fax:
Mailing address:
  • Phone: 330-328-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number181964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: