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General NPI Number Information
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NPI Number | 1396889036
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Entity Type | Organization
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Legal Business Name | TODD JACOBS PA
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 4725 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4603
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Country | US
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Telephone | 954-234-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 10055 VINTAGE PL
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City | PARKLAND
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State | FL
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Zip | 33076-3915
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Country | US
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Telephone | 954-234-6908
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL
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Name | MS. SUZANNE GARVY-CARR
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Credential |
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Telephone | 561-575-0643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | ME90301
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License Number State | FL
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