Individual
LUCAS JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
461 21ST AVE S, NASHVILLE, TN 37240-1104
(615) 322-4400
Mailing address
105 VIA GALICIA, SAN CLEMENTE, CA 92672-3827
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
281472
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
39796
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95038901
CA
Other
Enumeration date
01/13/2025
Last updated
04/18/2026
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