MEDICARE: MS. PATRICIA J JACOB FNP

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	363LF0000X	Family Nurse Practitioner	LG0000196	DE

General Provider Information

NPI Number	:	1982685038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA J JACOB FNP

Provider Business Mailing Address
First Line	:	100 S MAIN ST STE 207
Second Line	:
City	:	SMYRNA
State	:	DE
Zip	:	19977-1479
Country	:	US
Telephone Number	:	302-659-4490
Fax Number	:	302-659-4495

Provider Business Practice Location Address
First Line	:	100 S MAIN ST STE 207
Second Line	:
City	:	SMYRNA
State	:	DE
Zip	:	19977-1479
Country	:	US
Telephone Number	:	302-659-4490
Fax Number	:	302-659-4495

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/16/2016

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