Basic Information
| Provider Information | |||||||||
| NPI: | 1770255424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOB | ||||||||
| FirstName: | JOBIN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1978 NW 100TH WAY | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330241463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545625224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5000 W OAKLAND PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333131585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547356000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2021 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 9453262 | FL | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.