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NPI Code Detail

MEDICARE: ANGELA JACOBS CNP

MEDICARE: ANGELA JACOBS CNP
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
1363LN0005XCritical Care Neonatal Nurse PractitionerAPRN-11040305FL
2363LN0005XCritical Care Neonatal Nurse Practitioner4704220596MI
3363LN0000XNeonatal Nurse PractitionerAPRN-11040305FL
4363LN0000XNeonatal Nurse Practitioner4704220596MI

General Provider Information

NPI Number : 1912244146
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA JACOBS CNP
Provider Business Mailing Address
First Line : PO BOX 67000
Second Line : DEPARTMENT 272801
City : DETROIT
State : MI
Zip : 48267-0002
Country : US
Telephone Number : 517-788-4786
Fax Number : 517-796-6437
Provider Business Practice Location Address
First Line : 205 N EAST AVE
Second Line :
City : JACKSON
State : MI
Zip : 49201-1753
Country : US
Telephone Number : 517-788-4786
Fax Number : 517-796-6437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2013
Last Update Date : 01/22/2026

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