Jacqueline Marie Jacob

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

License

RN.382563 Issued in OH

Practice address

608 E Union St
Medina, OH 44256-1962

Phone

(330) 591-0787

NPI assigned

Dec 4, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1043815145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 E UNION ST",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561962",
            "telephone_number": "330-591-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 E UNION ST",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561962",
            "telephone_number": "330-591-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "OH",
            "license": "RN.382563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenna S Jackson, M.D.
• Krista Jackson, LPN
• Qiana Caprice Jackson
• Raytionna Danielle Jackson
• Sarah Murtha Jackson
• Dennette Kaye Jacoby
• Shail Jain, M.D.
• Sushil Kumar Jain, MD
• Than Mal Jain, MD
• Chris John Jaks

• Home Health Registered Nurse in Medina, OH
• Providers in Medina, OH by specialty
• Home Health Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.