Healthcare Provider Details

I. General information

NPI: 1376341552
Provider Name (Legal Business Name): BRILYN E JACOBSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 E BUCKHILL RD
FRESNO CA
93720-0604
US

IV. Provider business mailing address

724 POLLASKY AVE
CLOVIS CA
93612-1840
US

V. Phone/Fax

Practice location:
  • Phone: 747-214-4399
  • Fax:
Mailing address:
  • Phone: 747-214-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95034136
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number95034136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: