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General NPI Number Information
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NPI Number | 1366904229
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Entity Type | Individual
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Provider Name | JACOB PROWS
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 11806 ATLANTIC BLVD STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2968
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Country | US
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Telephone | 904-999-3386
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Fax |
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Provider Business Mailing Address
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Address Line | 11806 ATLANTIC BLVD STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2968
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Country | US
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Telephone | 904-999-3386
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Fax |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN29907
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License Number State | FL
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