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General NPI Number Information
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NPI Number | 1366037160
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Entity Type | Individual
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Provider Name | SANDRA SUE JACOBS APRN
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Gender | Female
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 3801 SPRINGHURST BLVD STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-6137
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Country | US
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Telephone | 502-394-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 11613 MAPLE WAY
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City | LOUISVILLE
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State | KY
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Zip | 40229-2212
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Country | US
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Telephone | 502-214-0206
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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 | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3015884
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License Number State | KY
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