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NPI Code Detail

MEDICARE: LISHA JACOB

MEDICARE: LISHA JACOB
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
1163WG0000XGeneral Practice Registered Nurse916213TX
2367500000XCertified Registered Nurse Anesthetist1213293TX

General Provider Information

NPI Number : 1194440222
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISHA JACOB
Provider Business Mailing Address
First Line : 2049 LAKE BEND DR
Second Line :
City : IRVING
State : TX
Zip : 75060-7743
Country : US
Telephone Number : 214-780-6061
Fax Number :
Provider Business Practice Location Address
First Line : 6201 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75235-5202
Country : US
Telephone Number : 214-645-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2022
Last Update Date : 03/02/2026

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Directions to “ LISHA JACOB ” Practice Location

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