Wendy Jacobs, Jd, Phd, Pa | |
2650 Bahia Vista St Ste 201 Sarasota FL 34239-2625 | |
(941) 402-7520 | |
Not Available |
Full Name | Wendy Jacobs, Jd, Phd, Pa |
---|---|
Speciality | Psychologist |
Location | 2650 Bahia Vista St Ste 201, Sarasota, Florida |
Authorized Official Name and Position | Wendy L Jacobs (OWNER) |
Authorized Official Contact | 9414027520 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Wendy Jacobs, Jd, Phd, Pa Po Box 17263 Sarasota FL 34276-0263 Ph: (941) 402-7520 | Wendy Jacobs, Jd, Phd, Pa 2650 Bahia Vista St Ste 201 Sarasota FL 34239-2625 Ph: (941) 402-7520 |
NPI Number | 1447520010 |
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Provider Enumeration Date | 01/12/2012 |
Last Update Date | 11/10/2020 |
Certification Date | 11/10/2020 |
Medicare PECOS PAC ID | 5294902359 |
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Medicare Enrollment ID | O20120113000196 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447520010 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | PY6367 (Florida) | Primary |
Provider Name | Wendy L Jacobs |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1174633242 PECOS PAC ID: 1759557341 Enrollment ID: I20120103000503 |
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