Individual
THERESA A JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2304 E GENEVA DR, TEMPE, AZ 85282-4147
(480) 878-5306
Mailing address
2250 E GERMANN RD, STE 2, CHANDLER, AZ 85286
(480) 878-5306
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP2138
AZ
363L00000X
Nurse Practitioner
RN063885
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z9842
HEALTHNET
AZ
05
—
938798-03
—
AZ
Enumeration date
08/24/2005
Last updated
07/24/2017
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