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General NPI Number Information
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NPI Number | 1831798685
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Entity Type | Individual
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Provider Name | JACOB DON PAUL DNP, APRN, ACNPC-AG
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Gender | Male
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 417 STATE ST STE 421
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City | BANGOR
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State | ME
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Zip | 04401-6639
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Country | US
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Telephone | 207-973-5293
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Fax |
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Provider Business Mailing Address
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Address Line | 340 S MOSELEY ST
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City | DE LEON
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State | TX
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Zip | 76444-2136
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Country | US
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Telephone | 254-734-5685
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 1008915
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License Number State | TX
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