Dr. Jacob Small, PA

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2163832 Issued in FL

Legal business name

DR. JACOB SMALL, PA

Practice address

13805 SW 78TH CT
Palmetto Bay, FL 33158-1109

Phone

(305) 972-2614

NPI assigned

Dec 13, 2012

Last updated

May 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacob SmallNPI 1477550176

Title

President

Phone

(305) 972-2614

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jacob Small, Professional Association Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob Small, PHD, ARNP-C

  • Nurse Practitioner
  • Palmetto Bay, FL
  • NPI 1477550176
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1649516030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13805 SW 78TH CT",
            "city": "PALMETTO BAY",
            "state": "FL",
            "postal_code": "331581109",
            "telephone_number": "305-972-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13805 SW 78TH CT",
            "city": "PALMETTO BAY",
            "state": "FL",
            "postal_code": "331581109",
            "telephone_number": "305-972-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JACOB SMALL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-972-2614"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "2163832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304943400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Jacob Small, Professional Association",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Nurse Practitioner in Palmetto Bay, FL
• Providers in Palmetto Bay, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.