Active NPI
Jennifer E Jacobsen, LMT
- Specialist
- St Augustine, FL
National Provider Identifier
1154587624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 46676
- Practice address
- 2200 N Ponce de Leon Blvd
Suite 12
St Augustine, FL 32084-2600 - Phone
- (904) 392-6588
- NPI assigned
- Aug 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA 46676 | FL | Primary |
Addresses
Primary practice location
2200 N Ponce de Leon Blvd
Suite 12
St Augustine, FL 32084-2600
Mailing address
15A Atlantic Oaks Cir
St Augustine, FL 32080-6876
Phone (904) 392-6588
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 |
|---|---|---|---|
| MA 46676 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217808000000",
"number": "1154587624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15A ATLANTIC OAKS CIR",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320806876",
"telephone_number": "904-392-6588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 N PONCE DE LEON BLVD",
"address_2": "SUITE 12",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320842600",
"telephone_number": "904-392-6588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "JENNIFER",
"middle_name": "E",
"name_prefix": "Miss",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-04",
"last_updated": "2008-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA 46676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.