Individual
SUSAN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
212 ANGELA LN, STAFFORD, TX 77477
(281) 781-9578
Mailing address
212 ANGELA LN, STAFFORD, TX 77477-4626
(281) 781-9578
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP126808
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP126808
TX
Other
Enumeration date
09/28/2015
Last updated
08/10/2018
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