Provider Demographics
NPI:1366871782
Name:JACOBSON, TAWNIA LYNN (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:TAWNIA
Middle Name:LYNN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:TAWNIA
Other - Middle Name:LYNN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 BUNGALOW TER
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1234
Mailing Address - Country:US
Mailing Address - Phone:032-623-2512
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:203-623-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA223064367500000X
CT5597367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered