Healthcare Provider Details

I. General information

NPI: 1386571784
Provider Name (Legal Business Name): AMBER LEE JACOBS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21914 PACIFIC WAY
OCEAN PARK WA
98640-3209
US

IV. Provider business mailing address

21914 PACIFIC WAY
OCEAN PARK WA
98640-3209
US

V. Phone/Fax

Practice location:
  • Phone: 360-518-9998
  • Fax: 360-845-2086
Mailing address:
  • Phone: 360-518-9998
  • Fax: 360-845-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP70128640-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: