Healthcare Provider Details

I. General information

NPI: 1104743806
Provider Name (Legal Business Name): JAKOBE TAYLOR FITZGERALD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 LONGWOOD AVE
BOSTON MA
02115-5804
US

IV. Provider business mailing address

1090 BEAUMONT DR
SAN JOSE CA
95129-3201
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2850
  • Fax:
Mailing address:
  • Phone: 408-505-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: