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General NPI Number Information
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NPI Number | 1235488446
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Entity Type | Individual
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Provider Name | HEATHER JOAN JACOBS FNP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 815 OAKRIDGE BLVD
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City | LUMBERTON
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State | NC
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Zip | 28358-2330
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Country | US
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Telephone | 910-738-7166
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Fax | 910-738-3764
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Provider Business Mailing Address
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Address Line | 2600 N ELM ST
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City | LUMBERTON
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State | NC
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Zip | 28358-3011
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Country | US
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Telephone | 910-670-5290
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Fax | 910-738-3674
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5005747
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License Number State | NC
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