Active NPI
Carol Ilma Jacobs, NP
- Adult Health Nurse Practitioner
- Cleveland, WI
National Provider Identifier
1255354064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 137
- Practice address
- 1205 North Ave
Cleveland, WI 53015-1413 - Phone
- (920) 693-5600
- Fax
- (920) 693-5604
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 137 | WI | Primary |
Addresses
Primary practice location
1205 North Ave
Cleveland, WI 53015-1413
Mailing address
1274 Meadowbrook Drive
Cleveland, WI 53015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137 | WI | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255354064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1274 MEADOWBROOK DRIVE",
"city": "CLEVELAND",
"state": "WI",
"postal_code": "53015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1205 NORTH AVE",
"city": "CLEVELAND",
"state": "WI",
"postal_code": "530151413",
"telephone_number": "920-693-5600",
"fax_number": "920-693-5604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "CAROL",
"middle_name": "ILMA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "WI",
"license": "137",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.