Ancy Chakkalakal Jacob, FNP-C
Nurse Practitioner, Family in Chicago, IL. Individual provider (NPI-1).
NPI number1457779639
StatusActive
Last updated in NPPESApr 26, 2021
Details
- NPI
- 1457779639
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Ancy Chakkalakal Jacob
- Credential
- FNP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 3, 2014
- Certification date
- Apr 26, 2021
- Last updated
- Apr 26, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209.011429 | IL | Yes |
| 163WH1000X | Registered Nurse, Hospice | 041-306342 | IL |
Practice location
1969 W Ogden AveChicago, IL 60612-3765
Phone 312-864-4395 · Fax 312-864-9500
Mailing address
1950 W Polst St. Professional Building, 6 Th Fl. # 17Chicago, IL 60612
Phone 312-864-4395 · Fax 312-864-9500
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