Individual
JERRY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
10058 NW 49TH PL, CORAL SPRINGS, FL 33076-2418
(954) 895-9745
Mailing address
10058 NW 49TH PL, CORAL SPRINGS, FL 33076-2418
(954) 895-9745
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
9454105
FL
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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