Individual
CHRISTINA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8645
(407) 324-7311
Mailing address
269 VAN GOGH CIR, BRANDON, FL 33511-7441
(407) 534-4136
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9113473
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
0
FL
Enumeration date
06/07/2021
Last updated
06/07/2021
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