Provider Demographics
NPI:1043515414
Name:JACOBS, ABBY JEAN (NP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:JEAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:JEAN
Other - Last Name:VAN DEN BROEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:PO BOX 889442
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-9442
Mailing Address - Country:US
Mailing Address - Phone:559-603-7372
Mailing Address - Fax:
Practice Address - Street 1:2755 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6800
Practice Address - Country:US
Practice Address - Phone:559-603-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner