Provider Demographics
NPI:1073345815
Name:JACOB, CRISTINE
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SW 107TH AVE # 1113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1302
Mailing Address - Country:US
Mailing Address - Phone:954-593-0105
Mailing Address - Fax:
Practice Address - Street 1:700 SW 107TH AVE # 1113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1302
Practice Address - Country:US
Practice Address - Phone:954-593-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program