Healthcare Provider Details

I. General information

NPI: 1740372960
Provider Name (Legal Business Name): BRENDA A JACOBSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 LA PAZ ST
PENSACOLA FL
32506-9709
US

IV. Provider business mailing address

29 RIDGE DR
GERING NE
69341-1522
US

V. Phone/Fax

Practice location:
  • Phone: 850-458-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18732A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS8359
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.006809
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS8359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: