Active NPI
Ashley Nicole Jacobson
- Psychologist
- St Petersburg, FL
National Provider Identifier
1104548957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY12361
- Practice address
- 9887 4TH St N Ste 319
St Petersburg, FL 33702-8445 - Phone
- (727) 490-8665
- NPI assigned
- Sep 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY12361 | FL | Primary |
Addresses
Primary practice location
9887 4TH St N Ste 319
St Petersburg, FL 33702-8445
Mailing address
430 3Rd Ave S Apt 278
St Petersburg, FL 33701-4186
Phone (352) 989-0891
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY12361 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1104548957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 3RD AVE S APT 278",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337014186",
"telephone_number": "352-989-0891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9887 4TH ST N STE 319",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337028445",
"telephone_number": "727-490-8665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "ASHLEY",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-16",
"last_updated": "2024-09-03",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY12361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.