Provider Demographics
NPI:1699747808
Name:JACOBS, MARGARET MARY (FNP-PA-C)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARY
Last Name:JACOBS
Suffix:
Gender:F
Credentials:FNP-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:PO BOX 3308
Mailing Address - Street 2:2518 ASPEN WAY
Mailing Address - City:ARNOLD
Mailing Address - State:CA
Mailing Address - Zip Code:95223-3308
Mailing Address - Country:US
Mailing Address - Phone:209-768-4739
Mailing Address - Fax:
Practice Address - Street 1:2037 HWY 4
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223
Practice Address - Country:US
Practice Address - Phone:209-795-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493773163W00000X
CA14787363A00000X
CANPF 10304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03560ZMedicare ID - Type Unspecified
CAS88288Medicare UPIN