Most Relevant Information
Provider Data
| NPI Number: | 1003228537 |
| Provider Name: | CHARLEEN JACOBS NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2200X |
| Specialty: | Nurse Practitioner |
| License Number: | F306841 |
Most Important Dates
| Enumeration Date: | 06/02/2014 |
| Last Updated: | 06/02/2014 |
Provider Practice Location
3444 KOSSUTH AVE
MMG FAMILY CARE CENTER
BRONX
NY
104672410
Practice Location Phone/Fax
| Phone: | 7189202273 |
| Fax: |
Provider Mailing Location
1 FISHER DR APT 202
MOUNT VERNON
NY
105523635
Provider Mailing Phone/Fax
| Phone: | 9147749210 |
| Fax: |