Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1-116446 | AL |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-116446 | AL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1-116446 | AL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-116446 | AL |
N | 363LC1500X | Nurse Practitioner - Community Health | 1-116446 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-116446 | AL |
NPI | 1689207391 |
---|---|
Provider Name | Mr. Mark Jason Cobb |
First Address | Ohatchee, AL 36271-0136 |
Second Address | Gadsden, AL 35901-5304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2020 |
Last Update Date | 20/02/2020 |