Healthcare Provider Details

I. General information

NPI: 1740312339
Provider Name (Legal Business Name): JEANINE JACOBS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 SPARTA ST
MC MINNVILLE TN
37110-1317
US

IV. Provider business mailing address

1514 SPARTA ST
MC MINNVILLE TN
37110-1317
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-8400
  • Fax: 931-473-0620
Mailing address:
  • Phone: 931-473-8400
  • Fax: 931-473-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000005149
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: