Provider Demographics
NPI:1578292470
Name:JACOBS, JORDAN MACKENZIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MACKENZIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MCCALLIE AVE
Mailing Address - Street 2:615 MCCALLIE AVE
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2598
Mailing Address - Country:US
Mailing Address - Phone:423-425-2266
Mailing Address - Fax:423-425-2305
Practice Address - Street 1:615 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2598
Practice Address - Country:US
Practice Address - Phone:423-425-2266
Practice Address - Fax:423-425-2305
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily