Healthcare Provider Details

I. General information

NPI: 1780557140
Provider Name (Legal Business Name): ANNELISE JACOBSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2496
  • Fax:
Mailing address:
  • Phone: 319-356-2902
  • Fax: 319-353-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA187172
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: