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General NPI Number Information
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NPI Number | 1023763695
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Entity Type | Individual
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Provider Name | JACOB M ANDREASEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/13/2022
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5540 SARATOGA BLVD STE 200
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-2999
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Country | US
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Telephone | 361-993-8510
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Fax | 361-985-2917
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Provider Business Mailing Address
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Address Line | 1714 W 56TH ST APT D110
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City | KEARNEY
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State | NE
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Zip | 68845-4123
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Country | US
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Telephone | 308-440-4726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2730
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License Number State | NE
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