Healthcare Provider Details

I. General information

NPI: 1336702646
Provider Name (Legal Business Name): HANNAH JACOBSEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH AGREN PA

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 CALIFORNIA ST STE 203
SAN FRANCISCO CA
94118-1892
US

IV. Provider business mailing address

3490 CALIFORNIA ST STE 203
SAN FRANCISCO CA
94118-1892
US

V. Phone/Fax

Practice location:
  • Phone: 415-593-1134
  • Fax:
Mailing address:
  • Phone: 415-593-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: