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NPI Code Detail

MEDICARE: JACOB OLSEN NURSE PRACTITIONER

MEDICARE: JACOB OLSEN NURSE PRACTITIONER
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95024663CA

General Provider Information

NPI Number : 1336841204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB OLSEN NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1 PARK PLZ STE 600
Second Line :
City : IRVINE
State : CA
Zip : 92614-5987
Country : US
Telephone Number : 949-828-1546
Fax Number : 949-629-7445
Provider Business Practice Location Address
First Line : 1 PARK PLZ STE 600
Second Line :
City : IRVINE
State : CA
Zip : 92614-5987
Country : US
Telephone Number : 949-828-1546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 03/03/2026

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