Provider Demographics
NPI:1699445874
Name:JACOBO, CHRISTY (RN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 SE CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3540
Mailing Address - Country:US
Mailing Address - Phone:702-773-7869
Mailing Address - Fax:
Practice Address - Street 1:11050 SE CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3540
Practice Address - Country:US
Practice Address - Phone:702-773-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608791RN163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology