Individual
JACOB CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3917 WEST RD STE A3917, LOS ALAMOS, NM 87544-2275
(505) 661-8959
(505) 661-8916
Mailing address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8959
(505) 661-8916
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 9409391
FL
363LF0000X
Family Nurse Practitioner
Primary
11005429
FL
Other
Enumeration date
03/22/2016
Last updated
08/26/2025
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