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General NPI Number Information
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NPI Number | 1881493278
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Entity Type | Individual
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Provider Name | MRS. ALEXANDRA SHELBY JACOBSEN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 12880 US 301
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City | DADE CITY
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State | FL
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Zip | 33525-5801
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Country | US
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Telephone | 352-584-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 17250 PARRISH GROVE RD
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City | DADE CITY
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State | FL
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Zip | 33523-6327
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Country | US
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Telephone | 813-702-2643
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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