Smith, Jacob

Smith, Jacob is an sole proprietor health care provider with primary practice located at 1111 Trinity Ln Ste 111 , Bloomington IL 61704-8112. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Smith, Jacob can be contacted via phone (309) 663-6461.

Contact Information

Primary practice address
1111 Trinity Ln Ste 111 Bloomington IL 61704-8112
Phone: (309) 663-6461
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085008559 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085008559 Illinois

Profile Details

NPI number 1548675945
LBN Legal business name Smith, Jacob
Credentials PA-C, ATC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 24th, 2014
Last updated Mar 30th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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