Individual
JACOB SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, ARNP-C
Contact information
Practice address
13805 SW 78TH CT, PALMETTO BAY, FL 33158-1109
(305) 972-2614
Mailing address
13805 SW 78TH CT, PALMETTO BAY, FL 33158-1109
(305) 972-2614
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME51250
FL
363L00000X
Nurse Practitioner
Primary
ARNP2163832
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304943400
—
FL
Enumeration date
07/07/2005
Last updated
05/09/2024
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