Provider Demographics
NPI:1366630642
Name:JACOB, BETSY (APN)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TIFFANY PT STE 203
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2916
Mailing Address - Country:US
Mailing Address - Phone:630-828-6821
Mailing Address - Fax:727-473-3368
Practice Address - Street 1:1 TIFFANY PT STE 203
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2916
Practice Address - Country:US
Practice Address - Phone:630-828-6821
Practice Address - Fax:727-473-3368
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily