Individual
CARLA JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(347) 268-4390
Mailing address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(347) 268-4390
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
542089
NY
363LF0000X
Family Nurse Practitioner
340624
NY
363LF0000X
Family Nurse Practitioner
Primary
R248512
MD
Other
Enumeration date
09/16/2010
Last updated
08/24/2023
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