Christina Jacob, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9113473 Issued in FL

Practice address

4930 E Lake Mary Blvd
Sanford, FL 32771-5003

Phone

(407) 322-8645

Fax

(407) 324-7311

NPI assigned

Jun 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Halifax Healthcare Systems Inc

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530
  Care Compare group

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1295302495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 VAN GOGH CIR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335117441",
            "telephone_number": "407-534-4136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 E LAKE MARY BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715003",
            "telephone_number": "407-322-8645",
            "fax_number": "407-324-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "CHRISTINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9113473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "0",
            "affiliation": "N",
            "endpointDescription": "0",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "0",
            "address_1": "269 Van Gogh Circle",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "0",
            "affiliation": "N",
            "endpointDescription": "0",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "0",
            "address_1": "269 Van Gogh Cir",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335117441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J D Mobile Health Services Inc
• Bernadete Jackson
• Deja Jackson
• Kimcheree Jackson
• Taiwan Jackson, LPN
• Thomas Jacobson
• Ram N Jadon, APRN
• Aasiyah Jaffer
• Jenni Jagers, PA-C
• James E Hirsch DC PA

• Physician Assistant in Sanford, FL
• Providers in Sanford, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.