Provider Demographics
NPI:1730172503
Name:JACOBUS, DANELLE ANDEE (PAC)
Entity type:Individual
Prefix:MS
First Name:DANELLE
Middle Name:ANDEE
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:100 COVEY DR STE 105
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5603
Practice Address - Country:US
Practice Address - Phone:615-794-2747
Practice Address - Fax:615-591-0460
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA809207RG0100X, 363A00000X
TN809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3668885Medicaid
3668885Medicare ID - Type Unspecified
TN3668885Medicaid