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General NPI Number Information
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NPI Number | 1730551425
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Entity Type | Individual
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Provider Name | TONIA JACOB APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1009 S. WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-4493
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Country | US
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Telephone | 312-996-6771
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-3747
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 103325
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209030618
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License Number State | IL
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