MEDICARE: JANET JACOB ANP

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	363L00000X	Nurse Practitioner	780	AK

Other Identifiers

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

General Provider Information

NPI Number	:	1326149709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET JACOB ANP

Provider Business Mailing Address
First Line	:	PO BOX 4105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4105
Country	:	US
Telephone Number	:	866-907-1068
Fax Number	:	425-917-9141

Provider Business Practice Location Address
First Line	:	3340 PROVIDENCE DR
Second Line	:	SUITE 351
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4691
Country	:	US
Telephone Number	:	907-212-4824
Fax Number	:	907-212-4831

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	02/05/2021

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Directions to “ JANET JACOB ANP” Practice Location

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