Active NPI
Jovanna C Dirusso, PA
- Physician Assistant
- Everett, WA
National Provider Identifier
1205954815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10005167
- Practice address
- 1717 13TH St Ste 300
Everett, WA 98201-1621 - Phone
- (425) 297-5500
- NPI assigned
- Mar 26, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10005167 | WA | Primary |
Addresses
Primary practice location
1717 13TH St Ste 300
Everett, WA 98201-1621
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900
Other names 1
- Jovanna C Jacobson
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1205954815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-258-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 13TH ST STE 300",
"city": "EVERETT",
"state": "WA",
"postal_code": "982011621",
"telephone_number": "425-297-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRUSSO",
"first_name": "JOVANNA",
"middle_name": "C",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10005167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOVANNA",
"last_name": "JACOBSON",
"middle_name": "C",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.