Provider Demographics
NPI:1598414716
Name:USKAVITCH, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:USKAVITCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:A-2200 MCN (2582)
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2582
Mailing Address - Country:US
Mailing Address - Phone:615-343-4578
Mailing Address - Fax:615-343-6160
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:A-2200 MCN (2582)
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2582
Practice Address - Country:US
Practice Address - Phone:615-343-4578
Practice Address - Fax:615-343-6160
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program