Provider Demographics
NPI:1528751039
Name:JACOBS, CARRIE JONES
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JONES
Last Name:JACOBS
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 1:16989 NW EG BUCK LARKINS RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3976
Mailing Address - Country:US
Mailing Address - Phone:850-294-1183
Mailing Address - Fax:
Practice Address - Street 1:6012 MAGNOLIA BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-7065
Practice Address - Country:US
Practice Address - Phone:850-236-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15256224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant