Provider Demographics
NPI:1548776842
Name:JACOBS, HEATHER A (RN, CNM, NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN, CNM, NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:SHERIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5103
Mailing Address - Country:US
Mailing Address - Phone:206-326-3000
Mailing Address - Fax:877-515-2975
Practice Address - Street 1:310 15TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5103
Practice Address - Country:US
Practice Address - Phone:206-326-3000
Practice Address - Fax:877-515-2975
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61054511367A00000X
CA235917176B00000X
CA95007948363LW0102X
CA95069356163W00000X
CNM04610367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse