MEDICARE: BRILYN JACOBSEN MEDICAL PRACTITIONER INC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073470621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILYN JACOBSEN MEDICAL PRACTITIONER INC

Provider Business Mailing Address
First Line	:	724 POLLASKY AVE BLDG 1/2
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-1840
Country	:	US
Telephone Number	:	559-207-3924
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 POLLASKY AVE BLDG 1/2
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-1840
Country	:	US
Telephone Number	:	559-207-3924
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRILYN JACOBSEN
Credential	:	NP
Telephone Number	:	747-214-4399

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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