Individual
JUSTINA MARIE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
11925 SHELDON RD, TAMPA, FL 33626-3644
(727) 581-8760
Mailing address
1225 W BAY DR, LARGO, FL 33770-2203
(727) 581-8706
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC005903
FL
152W00000X
Optometrist
Primary
OPC5903
FL
Other
Enumeration date
06/28/2019
Last updated
02/14/2022
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