Individual
GEETHA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP131595
TX
Other
Enumeration date
09/07/2016
Last updated
10/16/2020
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