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1649703307 NPI number — TINA MARIE JACOBS PA

NPI Number: 1649703307
Health Care Provider/Practitioner: TINA MARIE JACOBS PA

Information about “1649703307” NPI (TINA MARIE JACOBS PA) exists in 1649703307 in HTML format HTML  |  1649703307 in plain Text format TXT  |  1649703307 in PDF (Portable Document Format) PDF  |  1649703307 in an XML format XML  formats.

NPI Number : 1649703307 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649703307",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACOBS",
    "FirstName": "TINA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JESELUN",
    "OtherFirstName": "TINA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10269 W WESLEY PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKEWOOD",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80227-3074",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-807-7941",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3609 S WADSWORTH BLVD STE 135",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKEWOOD",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80235-2126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "720-542-8445",
    "PracticeLocationAddressFaxNumber": "877-413-4043",
    "EnumerationDate": "04/09/2017",
    "LastUpdateDate": "02/03/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA.0005501",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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