MEDICARE: KARLISLE JAKOSALEM FNP-C

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	208D00000X	General Practice Physician	NP95031669	CA

General Provider Information

NPI Number	:	1124978507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLISLE JAKOSALEM FNP-C

Provider Business Mailing Address
First Line	:	3400 W BALL RD STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3737
Country	:	US
Telephone Number	:	714-828-2554
Fax Number	:	714-828-6267

Provider Business Practice Location Address
First Line	:	3400 W BALL RD STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3737
Country	:	US
Telephone Number	:	714-828-2554
Fax Number	:	714-828-6267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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