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NPI Code Detail

MEDICARE: SUSAN E. JACOBSON NP

MEDICARE: SUSAN E. JACOBSON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse001500246VA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner0024167284VA
3364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist0015000246VA

General Provider Information

NPI Number : 1063541977
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN E. JACOBSON NP
Provider Business Mailing Address
First Line : 4131 EVERGREEN DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22032-1018
Country : US
Telephone Number : 703-289-7560
Fax Number : 703-289-4612
Provider Business Practice Location Address
First Line : 3020 JAVIER RD
Second Line : INOVA BEHAVIORAL HEALTH
City : FAIRFAX
State : VA
Zip : 22031-4609
Country : US
Telephone Number : 703-289-7585
Fax Number : 703-289-4612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 03/09/2011

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