Healthcare Provider Details

I. General information

NPI: 1609289743
Provider Name (Legal Business Name): JENNIFER LYNN JACOBS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 12/05/2023
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 602-849-0115
  • Fax: 602-246-7029
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP5614
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP5614
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: