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Individual

JACOB G THOELE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
AGACNP-C

Contact information

Practice address
910 E HOUSTON ST STE 550, TYLER, TX 75702-8366
(903) 606-8718
(903) 606-1218
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP137474
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
391691801
TX
01
8KC686
BCBS
TX
01
P02137154
MEDICARE RAIL ROAD
TX
Enumeration date
09/05/2018
Last updated
12/30/2025
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