License holder summary

STACIE LYNNE JACOBY is a Board Of Medicine licensed to practice in Idaho. The address on file for STACIE LYNNE JACOBY is 3600 E EMORY AVE Nampa ID 83686. This licensed professional license is not current. The license was granted 08/03/2004 and expired on 08/01/2011.

Idaho

Division of Occupational and Professional Licenses

STACIE LYNNE JACOBY
Board Of Medicine
License number
LRT-1068
Date granted
08/03/2004
Date expires
08/01/2011
Class
Board Of Medicine
Status
Canceled
Address
3600 E EMORY AVE Nampa ID 83686
idaholicensing.com
ID 48329435
LAST UPDATED 2024-03-02 04:19:50 UTC

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