Individual
ANDREW NATHAN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(918) 582-1972
Mailing address
512 N VINE CT, JENKS, OK 74037-3474
(918) 200-1088
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OK
Other
Enumeration date
05/23/2026
Last updated
05/23/2026
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