Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | ARNP9169009 | FL |
Y | 363L00000X | Nurse Practitioner | ARNP9169009 | FL |
NPI | 1013482249 |
---|---|
Provider Name | Sheeba Jacob |
First Address | Boynton Beach, FL 33426-7400 |
Second Address | Boynton Beach, FL 33426-7400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2018 |
Last Update Date | 03/10/2018 |