Provider Demographics
NPI:1508601634
Name:BARB, JACOB TANNER (RN)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TANNER
Last Name:BARB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 LEGACY DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0417
Mailing Address - Country:US
Mailing Address - Phone:972-943-6400
Mailing Address - Fax:
Practice Address - Street 1:7950 LEGACY DR STE 1000
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0417
Practice Address - Country:US
Practice Address - Phone:972-943-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN255632163W00000X, 163WC0200X, 163WN0002X, 163WN0003X, 163WP0200X, 163WP0218X, 163WP0807X, 163WA2000X
MTNHA-NHA-LIC-6721376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No376G00000XNursing Service Related ProvidersNursing Home Administrator