Individual
LAKENYA JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
937 COMMERCE RD SE, PALM BAY, FL 32909-4732
(321) 626-0930
Mailing address
937 COMMERCE RD SE, PALM BAY, FL 32909-4732
(321) 626-0930
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108400
—
FL
Enumeration date
11/08/2018
Last updated
11/08/2018
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