Provider Demographics
NPI:1194168856
Name:JACOB, ASHLEY M (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:JACOB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-377-9200
Mailing Address - Fax:972-377-9300
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-377-9200
Practice Address - Fax:972-377-9300
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08212OtherNCCPA