Healthcare Provider Details

I. General information

NPI: 1790612497
Provider Name (Legal Business Name): LUCAS JACOBSEN PSYCHIATRIC NURSING A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 STEVENS AVE STE 206
SOLANA BEACH CA
92075-2065
US

IV. Provider business mailing address

462 STEVENS AVE STE 206
SOLANA BEACH CA
92075-2065
US

V. Phone/Fax

Practice location:
  • Phone: 858-786-0875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCAS JACOBSEN
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-C
Phone: 858-786-0875