Individual
PAUL B JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY5272
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59792
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/19/2006
Last updated
02/26/2008
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