Individual
TRACY JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
919 S. 10TH ST., LEESVILLE, LA 71446
(337) 404-4106
(337) 404-4108
Mailing address
PO BOX 130, NEW LLANO, LA 71461-0130
(337) 239-2207
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP10043
LA
Other
Enumeration date
07/02/2018
Last updated
07/30/2019
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