Healthcare Provider Details

I. General information

NPI: 1679437636
Provider Name (Legal Business Name): HEATHER JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CONTINENTAL PL STE 400
BRENTWOOD TN
37027-1073
US

IV. Provider business mailing address

2005 SILVERADO PASS
SPRING HILL TN
37174-3501
US

V. Phone/Fax

Practice location:
  • Phone: 901-286-2129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8219
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: