Provider Demographics
NPI:1932823523
Name:JACOBS, ASHLEY JUSTINE (CRNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JUSTINE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-9508
Mailing Address - Country:US
Mailing Address - Phone:215-589-0329
Mailing Address - Fax:
Practice Address - Street 1:5039 SWAMP RD STE 401
Practice Address - Street 2:
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9663
Practice Address - Country:US
Practice Address - Phone:215-230-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily