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NPI Code Detail

MEDICARE: JACOB HA FNP-C

MEDICARE: JACOB HA FNP-C
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
1363L00000XNurse PractitionerR221233MD

General Provider Information

NPI Number : 1295292407
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB HA FNP-C
Provider Business Mailing Address
First Line : 3306 LAUREL HILL RD
Second Line :
City : HANOVER
State : MD
Zip : 21076-2254
Country : US
Telephone Number : 410-302-9464
Fax Number :
Provider Business Practice Location Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 410-401-7575
Fax Number : 369-200-3590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2019
Last Update Date : 03/03/2025

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Directions to “ JACOB HA FNP-C” Practice Location

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