Provider Demographics
NPI:1376386599
Name:JACOBS, TRUDY
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
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 262
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:AZ
Mailing Address - Zip Code:85329-0262
Mailing Address - Country:US
Mailing Address - Phone:623-440-6439
Mailing Address - Fax:
Practice Address - Street 1:4851 S 117TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-4202
Practice Address - Country:US
Practice Address - Phone:216-244-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide