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General NPI Number Information
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NPI Number | 1952268617
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Entity Type | Individual
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Provider Name | JACOB ELIJAH GOOD DNP, CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 5700 AZ-90
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-263-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 64 HAYES ST
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City | THORSBY
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State | AL
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Zip | 35171-7546
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Country | US
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Telephone | 205-688-6354
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1-184390
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License Number State | AL
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