Basic Information
| Provider Information | |||||||||
| NPI: | 1417562877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 669 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853662329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282476516 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28841 COMMERCE WAY STE A3 | ||||||||
| Address2: | |||||||||
| City: | WELLTON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853567063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282476516 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2020 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 257790 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 11008997 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.