Provider Demographics
NPI:1124433610
Name:JACOB, JINSY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JINSY
Middle Name:ANNE
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:2225 CIVIC CENTER DR
Practice Address - Street 2:SUITE 224
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6338
Practice Address - Country:US
Practice Address - Phone:702-214-5948
Practice Address - Fax:702-214-9439
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC181719208000000X
NV16659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1124433610Medicaid