Individual
VICTORIA EDUARDOVNA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
817 W 700 S, SLC, UT 84104-1405
(801) 712-8850
Mailing address
817 W 700 S, SALT LAKE CITY, UT 84104-1405
(801) 712-8850
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5142656-4405
UT
363LF0000X
Family Nurse Practitioner
5142656-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5142656-4405
UT
Other
Enumeration date
02/28/2007
Last updated
12/04/2020
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