Provider Demographics
NPI:1487255659
Name:JACOBS, HEATHER NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9445 ROAD 180
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-8741
Mailing Address - Country:US
Mailing Address - Phone:260-557-3974
Mailing Address - Fax:
Practice Address - Street 1:9445 ROAD 180
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-8741
Practice Address - Country:US
Practice Address - Phone:260-557-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27061245A251J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care