Provider Demographics
NPI:1710564810
Name:JACOBS, ERICA (LPN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
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 1:5440 BUNDY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3034
Mailing Address - Country:US
Mailing Address - Phone:504-382-2732
Mailing Address - Fax:
Practice Address - Street 1:128 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5939
Practice Address - Country:US
Practice Address - Phone:985-651-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20160302164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse