MEDICARE: DR. LISA M JAACKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	34977	AZ
2	207V00000X	Obstetrics & Gynecology Physician	156775	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34977	OTHER	AZ	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295785913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M JAACKS MD

Provider Business Mailing Address
First Line	:	2010 E JOHNSON AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-6097
Country	:	US
Telephone Number	:	850-969-2038
Fax Number	:	850-969-2037

Provider Business Practice Location Address
First Line	:	2010 E JOHNSON AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-6097
Country	:	US
Telephone Number	:	850-969-2038
Fax Number	:	850-969-2037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/20/2026

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Directions to “ DR. LISA M JAACKS MD” Practice Location

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