Healthcare Provider Details

I. General information

NPI: 1891613550
Provider Name (Legal Business Name): BRANDI RENEE JACOBS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MCEWAN ST
CLARE MI
48617-1440
US

IV. Provider business mailing address

2482 S CLARE AVE
CLARE MI
48617-9755
US

V. Phone/Fax

Practice location:
  • Phone: 989-802-5251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704355631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: