| Provider / Organization | NPI | Date Certified |
|---|---|---|
| STACY JACOB | 1104333178 | 2023-01-21 |
Stacy Jacob is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1104333178. Registration indicates Stacy Jacob is a provider of services with a specialization in Nursing Service Providers, Licensed Practical Nurse (Licensed Practical Nurse, ) (Licensed Practical Nurse, Nursing Service Providers) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Miss Stacy Jacob |
| Practice Office Address | 475 SEAVIEW AVE STATEN ISLAND, NY US |
| Practice Office Telephone | 7182669000 |
| Mailing Address | 475 SEAVIEW AVE STATEN ISLAND, NY 103053436 US |
| Business Telephone | 7182269000 |
| Code | Practice | License No State |
|---|---|---|
| 164W00000X | Nursing Service Providers Licensed Practical Nurse Licensed Practical Nurse Licensed Practical Nurse Nursing Service Providers | 329541-1
NY |
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers |