MEDICARE: DR. MARIANNE BERNADETTE JACOBS D.O.

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	2084N0400X	Neurology Physician	31615	CO
2	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	31615	CO
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	31615	CO
4	2084N0400X	Neurology Physician	OS5346	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	57444Y	OTHER	FL	MEDICARE PTAN
6	P01290076	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84132889816	OTHER		SECURE HORIZONS
3	50813	OTHER	CT	STATE LICENSE
5	841328898011	OTHER		ROCKY MOUNTAIN HEALTH PLA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831118611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE BERNADETTE JACOBS D.O.

Provider Business Mailing Address
First Line	:	3 MARYLAND FARMS STE 200
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5005
Country	:	US
Telephone Number	:	615-345-5400
Fax Number	:	615-345-5405

Provider Business Practice Location Address
First Line	:	3109 SILKWOOD LN
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953-5686
Country	:	US
Telephone Number	:	615-345-5400
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/02/2020

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Directions to “ DR. MARIANNE BERNADETTE JACOBS D.O.” Practice Location

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