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NPI Code Detail

MEDICARE: JEANNINE M JACOBS CPNP

MEDICARE: JEANNINE M JACOBS CPNP
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
1363LP0200XPediatric Nurse Practitioner1686SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144270752
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE M JACOBS CPNP
Provider Business Mailing Address
First Line : 1 INDEPENDENCE PT
Second Line : SUITE 212
City : GREENVILLE
State : SC
Zip : 29615-4545
Country : US
Telephone Number : 864-797-6044
Fax Number :
Provider Business Practice Location Address
First Line : 29 N ACADEMY ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2629
Country : US
Telephone Number : 864-331-1300
Fax Number : 864-331-1447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 03/19/2014

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