LICIAMMA JACOB (NPI# 1134682347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134682347 |
| Entity Type | Individual |
| Full Name | LICIAMMA JACOB |
| Practice Address |
4600 E Sam Houston Pkwy S Pasadena TX 77505-3948 |
| Mailing Address |
2708 Raven Ridge Dr Pearland TX 77584-3442 |
| Practice Telephone | 7139487388 |
| Mailing Telephone | 7134361818 |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2019-04-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | AP138632 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4600 E SAM HOUSTON PKWY S |
| City | PASADENA |
| State | TX |
| Zip Code | 77505-3948 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487644910 | Cliff J Whigham Jr. | Radiology | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2005-10-26 |
| 1740810928 | Natalia Johnson | Registered Nurse | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2020-01-16 |
| 1356908750 | Pasadena Emergency Medicine Associates, Pa | Physician Assistant | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2019-05-22 |
| 1265958250 | Johnna Jay Cacace | Nurse Practitioner | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2017-08-21 |
| 1215304324 | Houston Medicine Associates, Pa | Internal Medicine | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2015-08-24 |
| 1710312301 | Stephen Michael Evankovich | Anesthesiologist Assistant | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2013-09-13 |
| 1053606111 | Robert Edwin Jones Iv | Anesthesiologist Assistant | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2011-06-16 |
| 1093032963 | Bay Area Emergency Partners | Emergency Medicine | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2010-04-30 |
| 1467680298 | Andrew Sumner | Anesthesiologist Assistant | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2009-07-01 |
| 1700014461 | Lan Nguyen | Anesthesiologist Assistant | 4600 E Sam Houston Pkwy S, Pasadena, TX 77505-3948 | 2009-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545742 | Travis Jones | Pharmacist | 6767 Spencer Highway, Pasadena, TX 77505 | 2020-10-16 |
| 1952872905 | Bay Area Internal Medicine Care Pllc | Internal Medicine | Baywood Crossing Rehabilitation and Healthcare Center, 5020 Space Center Blvd., Pasadena, TX 77505 | 2018-12-16 |
| 1750851325 | Leslie Jackson | Nurse Practitioner | 7106 Spencer Highway, Pasadena, TX 77505 | 2018-11-27 |
| 1093297459 | Hieu Ngoc Minh Hutt | Occupational Therapy Assistant | 4900 East Sam Houston Pkwy S, Pasadena, TX 77505 | 2018-09-02 |
| 1780189142 | Basewave Properties, Pllc | Psychiatry & Neurology | 4808 Fairmont Pkwy, #404, Pasadena, TX 77505 | 2018-03-28 |
| 1720596141 | Lyanne Marlen Fernandez | Specialist/Technologist | 6565 Spencer Hwy Apt 1114, Pasadena, TX 77505 | 2018-01-19 |
| 1073069811 | Sng - Pasadena Dialysis Center Lp | Clinic/Center | 5040 Crenshaw Rd, Ste 200, Pasadena, TX 77505 | 2016-08-31 |
| 1235683418 | Sharon Li | Nurse Practitioner | 4001 Preston Rd #100, Pasadena, TX 77505 | 2016-08-05 |
| 1225493687 | Skkz, Inc. | Clinic/Center | 6415 Fairmont Pkwy, Ste A, Pasadena, TX 77505 | 2015-12-29 |
| 1982026530 | Aerocare Home Medical, Inc. | Durable Medical Equipment & Medical Supplies | 5041 Spencer Hwy, Suite 603, Pasadena, TX 77505 | 2014-01-16 |
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| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295342772 | Gilead Associates LLC | Nurse Practitioner | 206 Mulberry Ridge Ct, Pasadena, MD 21122-7514 | 2020-09-28 |
| 1497302418 | Riane Suzanne Thrasher | Nurse Practitioner | 354 Mountain Rd # G1158, Pasadena, MD 21122-1158 | 2019-08-23 |
| 1750866414 | Joyce Marie Shedrick | Nurse Practitioner | 5050 Crenshaw Rd Ste 200, Pasadena, TX 77505-3139 | 2018-09-28 |
| 1831687185 | Stephanie Lynn Shortes | Nurse Practitioner | 6503 Saint Jude Dr, Pasadena, TX 77505-5450 | 2018-04-23 |
| 1235683418 | Sharon Li | Nurse Practitioner | 4001 Preston Rd #100, Pasadena, TX 77505 | 2016-08-05 |
| 1104297035 | Ashley Harris | Nurse Practitioner | 630 S Raymond Ave Unit 340, Pasadena, CA 91105-3206 | 2015-10-19 |
| 1548682750 | Prestige Healthcare LLC | Nurse Practitioner | 4235 Fernside Dr, Pasadena, TX 77505-4226 | 2014-01-08 |
| 1184051856 | Maureen Ann Carr | Nurse Practitioner | 67 El Nido Ave, Pasadena, CA 91107 | 2013-09-26 |
| 1467776096 | Hamida Khanmohammed | Nurse Practitioner | 393 East Walnut Street, Pasadena, Ca 91188, Southern California Permanente Medical Group, Pasadena, CA 91188 | 2010-03-25 |
| 1194909291 | Camille Lanette Awanda | Nurse Practitioner | 8111 Evening Star Dr, Suite 319, Pasadena, MD 21122-2399 | 2007-12-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.