Healthcare Provider Details

I. General information

NPI: 1902689425
Provider Name (Legal Business Name): YONATON A JACOBS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S 348TH ST STE A
FEDERAL WAY WA
98003-7042
US

IV. Provider business mailing address

710 S 348TH ST STE A
FEDERAL WAY WA
98003-7042
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8540
  • Fax: 253-661-4286
Mailing address:
  • Phone: 253-382-8540
  • Fax: 253-661-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61588691
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61588691
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60172888
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: