MEDICARE: RACHEL KAYLA JACOBOVITS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ15037600	NJ

General Provider Information

NPI Number	:	1114763323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL KAYLA JACOBOVITS FNP

Provider Business Mailing Address
First Line	:	27 S COOKS BRIDGE RD STE 2-14
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2463
Country	:	US
Telephone Number	:	732-876-3376
Fax Number	:	732-876-0276

Provider Business Practice Location Address
First Line	:	27 S COOKS BRIDGE RD STE 2-14
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2463
Country	:	US
Telephone Number	:	732-876-3376
Fax Number	:	732-876-0276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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