Provider Demographics
NPI:1922848084
Name:BODE, JACOB P (AG-ACNP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:P
Last Name:BODE
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:540-829-4100
Practice Address - Fax:540-829-4392
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024189256207RP1001X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease