Elizabeth Joan Jacobsen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA60259472 Issued in WA

Practice address

1807 N Hutchinson Rd
Spokane Valley, WA 99212-2444

Phone

(509) 456-7414

Fax

(509) 624-0763

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Dermatology and Skin Surgery PLLC

  • Clinical Medical Laboratory
  • Spokane Valley, WA
  • NPI 1972579845
  NPD
• Arizona Skin and Laser Therapy Institute, LTD

  • Dermatology Physician
  • Quartzsite, AZ
  • NPI 1427506203
  NPD (past)
• East Valley Dermatology RX, LLC

  • Non-Pharmacy Dispensing Site
  • Chandler, AZ
  • NPI 1013312925
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1154408631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "509-456-7414",
            "fax_number": "509-624-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "509-456-7414",
            "fax_number": "509-624-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "ELIZABETH",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60259472",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Frederick Jackson, LMT
• N Scott Jackson, PA-C
• Noah Jackson
• Amber Rose Jacober, SUDPT
• Alexys B Jacobs, CBT
• April Leigh Jacobson
• Eileen Jacobson, CP00003047
• Gabrielle Louise Jaeger
• James J Psomas DDS PS
• James Leale DDS, PLLC (Nightingale Family Dental)

• Medical Physician Assistant in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.