Provider Demographics
NPI:1861621831
Name:JENNIFER JACOBSON MSN PMHNP-BC PLLC
Entity type:Organization
Organization Name:JENNIFER JACOBSON MSN PMHNP-BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:520-870-9786
Mailing Address - Street 1:6812 N. ORACLE ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-219-0178
Mailing Address - Fax:520-297-2242
Practice Address - Street 1:6812 N. ORACLE ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-219-0178
Practice Address - Fax:520-297-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 106778 AP1265363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty