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General NPI Number Information
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NPI Number | 1154587624
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Entity Type | Individual
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Provider Name | JENNIFER E JACOBSEN LMT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 2200 N PONCE DE LEON BLVD SUITE 12
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2600
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Country | US
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Telephone | 904-392-6588
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Fax |
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Provider Business Mailing Address
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Address Line | 15A ATLANTIC OAKS CIR
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6876
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Country | US
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Telephone | 904-392-6588
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 46676
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License Number State | FL
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