Provider Demographics
NPI:1245696392
Name:READ, JACOB (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WILSHIRE BLVD STE 238-120
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5370
Mailing Address - Country:US
Mailing Address - Phone:865-213-2834
Mailing Address - Fax:835-213-5169
Practice Address - Street 1:336 WILSHIRE BLVD STE 238-120
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5370
Practice Address - Country:US
Practice Address - Phone:865-213-2834
Practice Address - Fax:835-213-5169
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02824363LF0000X
WAAP60650859363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily