Mary R Jacob, ARNP

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

ARNP 1859582 Issued in FL

Practice address

1600 S Orlando Ave
Winter Park, FL 32789-5547

Phone

(407) 644-4692

NPI assigned

Jul 5, 2006

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

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396776571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S ORLANDO AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895547",
            "telephone_number": "407-644-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ORLANDO AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895547",
            "telephone_number": "407-644-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MARY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP 1859582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annesia Katrina Jackson, RN
• Betsy Jackson, M.S.
• Brianna Jackson
• Gabrielle Jackson
• Monica Jackson, LMHC
• Melvin R. Jacob
• Siomara Yanilet Jacobo, LMT
• Kelly B Jacobson, PH.D.
• Rhonda Lynn Jacobson
• Jacqueline L. Kaiser M.D., P.a.

• Psychiatric/Mental Health Clinical Nurse Specialist in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Florida

• 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.

Verify at the official NPI Registry.