Individual
RYAN JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
201 STATE ST, ERIE, PA 16550-0002
(214) 604-9228
Mailing address
201 STATE ST, ERIE, PA 16550-0002
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN762749
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN762749
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN762749
PA RN LICENSE NUMBER
PA
Enumeration date
02/06/2024
Last updated
06/04/2025
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