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NPI Code Detail

MEDICARE: ALEXANDRA JACOBS

MEDICARE:   ALEXANDRA  JACOBS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOH

General Provider Information

NPI Number : 1720941990
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA JACOBS
Provider Business Mailing Address
First Line : 530 S MAIN ST
Second Line :
City : LIMA
State : OH
Zip : 45804-1500
Country : US
Telephone Number : 419-569-8859
Fax Number :
Provider Business Practice Location Address
First Line : 530 S MAIN ST
Second Line :
City : LIMA
State : OH
Zip : 45804-1500
Country : US
Telephone Number : 419-569-8859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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Directions to “ ALEXANDRA JACOBS ” Practice Location

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