MEDICARE: MRS. LISA MARIA JACOBS LPN, RN, BSN

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	163WH0200X	Home Health Registered Nurse	RN.414084	OH

General Provider Information

NPI Number	:	1184090011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIA JACOBS LPN, RN, BSN

Provider Business Mailing Address
First Line	:	5759 LIBERTY FAIRFIELD RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-6214
Country	:	US
Telephone Number	:	513-309-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	5759 LIBERTY FAIRFIELD RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-6214
Country	:	US
Telephone Number	:	513-309-2972
Fax Number	:

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

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	07/17/2025

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