Provider Demographics
NPI:1730962580
Name:JACOBS, FERNANDA N (DNP, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:N
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DNP, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8439
Mailing Address - Country:US
Mailing Address - Phone:847-535-6083
Mailing Address - Fax:847-234-4336
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8439
Practice Address - Country:US
Practice Address - Phone:847-535-6083
Practice Address - Fax:847-234-4336
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028349363LA2100X
IL041462060363LA2100X
IL209028349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care