Provider Demographics
NPI:1558248484
Name:JACOBY, CHRISTINA ESTELLE (AGCNS-BC, DNP, WCC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ESTELLE
Last Name:JACOBY
Suffix:
Gender:F
Credentials:AGCNS-BC, DNP, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 WALSH LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2960
Mailing Address - Country:US
Mailing Address - Phone:813-503-6467
Mailing Address - Fax:
Practice Address - Street 1:250 E ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2186
Practice Address - Country:US
Practice Address - Phone:505-995-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-87695163WC0200X, 163WE0900X
NM85540363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy