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General NPI Number Information
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NPI Number | 1508601634
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Entity Type | Individual
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Provider Name | JACOB TANNER BARB RN
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Gender | Male
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Dates
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Enumeration Date | 06/29/2024
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 7950 LEGACY DR STE 1000
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City | PLANO
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State | TX
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Zip | 75024-0417
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Country | US
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Telephone | 972-943-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 7950 LEGACY DR STE 1000
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City | PLANO
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State | TX
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Zip | 75024-0417
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Country | US
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Telephone | 972-943-6400
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 163WN0003X
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Taxonomy Name | Low-Risk Neonatal Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 163WP0218X
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Taxonomy Name | Pediatric Oncology Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 255632
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License Number State | TN
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Taxonomy #8
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | NHA-NHA-LIC-6721
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License Number State | MT
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Taxonomy #9
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 255632
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License Number State | TN
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