Individual
MS. DIANA MARY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5323 HARRY HINES BLVD STOP 7200, DALLAS, TX 75390-7201
(214) 648-6400
(214) 648-5461
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-0624
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA11109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
567256YL7A
—
TX
05
—
567258YNGS
—
TX
05
—
567259YL7B
—
TX
Enumeration date
02/28/2017
Last updated
11/14/2025
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