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General NPI Number Information
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NPI Number | 1366871782
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Entity Type | Individual
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Provider Name | TAWNIA LYNN JACOBSON APRN, CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3175
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Country | US
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Telephone | 203-623-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 5 BUNGALOW TER
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City | SANDY HOOK
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State | CT
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Zip | 06482-1234
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Country | US
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Telephone | 32-623-2512
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RNA223064
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 5597
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License Number State | CT
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