MEDICARE: ANEISHA B JACOBS RN, WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	RN290215	GA

General Provider Information

NPI Number	:	1720784846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANEISHA B JACOBS RN, WHNP-BC

Provider Business Mailing Address
First Line	:	7517 SPOLETO LOOP
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-6486
Country	:	US
Telephone Number	:	678-770-4808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 CLIFF VALLEY WAY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2421
Country	:	US
Telephone Number	:	404-728-7900
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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