Provider Demographics
NPI:1902141989
Name:COBB, JEAN WILLIAMS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:WILLIAMS
Last Name:COBB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 ASKEWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-7956
Mailing Address - Country:US
Mailing Address - Phone:252-209-4479
Mailing Address - Fax:
Practice Address - Street 1:711 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5643
Practice Address - Country:US
Practice Address - Phone:252-338-4400
Practice Address - Fax:252-337-7912
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily