Christy Jacobo, RN

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

201608791RN Issued in OR

Practice address

11050 SE Cherry Blossom Dr
Portland, OR 97216-3540

Phone

(702) 773-7869

NPI assigned

Sep 17, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1699445874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 SE CHERRY BLOSSOM DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163540",
            "telephone_number": "702-773-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 SE CHERRY BLOSSOM DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163540",
            "telephone_number": "702-773-7869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBO",
        "first_name": "CHRISTY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "OR",
            "license": "201608791RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "christy.jacobo@prestigecare.com",
            "affiliation": "Y",
            "endpointDescription": "vaccination",
            "affiliationName": "PHARMERICA DRUG SYSTEMS LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "vaccination assist",
            "address_1": "833 Marlborough Ave",
            "address_2": "SUITE 100",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925072133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peter Jacky, PHD, FACMG
• Jacob M Bell, DC
• Benjamin Jacob
• David Jacob, LMT
• Tirzah D Jacob, LPC
• Kimberly Jacobowitz, LCSW
• Betony M Jacobs
• Caroline N Jacobs, PHD, APRN
• Chad Christopher Jacobs, MED, LPC
• Christopher John Jacobs, B.S

• Gerontology Registered Nurse in Portland, OR
• Providers in Portland, OR by specialty
• Gerontology Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.