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Individual

THOMAS LARUE JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
475 S COLUMBIA RIVER HWY STE 105, SAINT HELENS, OR 97051-2860
(503) 397-7119
Mailing address
29134 OLD RAINIER RD, RAINIER, OR 97048-2300
(360) 818-4677

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201707769NP-PP
OR
363LF0000X
Family Nurse Practitioner
153353
AK
363LF0000X
Family Nurse Practitioner
201707769NP-PP
OR
363LF0000X
Family Nurse Practitioner
AP60785555
WA

Other

Enumeration date
08/14/2017
Last updated
02/17/2020
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