Healthcare Provider Details

I. General information

NPI: 1497697817
Provider Name (Legal Business Name): ANDREA JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 HARFORD RD STE 27
BALTIMORE MD
21214-3205
US

IV. Provider business mailing address

4709 HARFORD RD STE 27
BALTIMORE MD
21214-3205
US

V. Phone/Fax

Practice location:
  • Phone: 443-527-0875
  • Fax:
Mailing address:
  • Phone: 443-527-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0203627
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCSA-01098
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHCSA-01098
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: