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General NPI Number Information
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NPI Number | 1730840745
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Entity Type | Individual
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Provider Name | ASHTON JACOBS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 822 W 1ST ST STE 5
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2382
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Country | US
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Telephone | 317-957-2110
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Fax | 317-957-2050
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Provider Business Mailing Address
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Address Line | 3403 E RAYMOND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-4782
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Country | US
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Telephone | 317-957-2000
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Fax | 317-957-2050
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28225235A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71012218A
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License Number State | IN
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