Healthcare Provider Details

I. General information

NPI: 1942246392
Provider Name (Legal Business Name): NOELLE JACOBSEN CNM, PMHNP-C WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAITLAND AVE APT 142
ALTAMONTE SPRINGS FL
32701-5539
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

V. Phone/Fax

Practice location:
  • Phone: 206-207-7547
  • Fax: 206-339-1448
Mailing address:
  • Phone: 206-207-7547
  • Fax: 206-339-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-5219
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9214204
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number231955
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: