Individual
JACOB W OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
301 MED TECH PKWY STE 240, JOHNSON CITY, TN 37604
(423) 794-5520
(423) 282-6940
Mailing address
215 E SPRINGBROOK DR, JOHNSON CITY, TN 37601-1761
(423) 794-5520
(423) 282-6940
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202305
TN
363L00000X
Nurse Practitioner
Primary
22831
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q030858
—
TN
Enumeration date
07/07/2017
Last updated
05/02/2020
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