| 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 |
|---|---|
| Provider Enumeration Date | 01/12/2012 |
| Last Update Date | 11/10/2020 |
| Certification Date | 11/10/2020 |
| Medicare PECOS PAC ID | 5294902359 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174633242 PECOS PAC ID: 1759557341 Enrollment ID: I20120103000503 |
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