Active NPI
Diana Lynn Jacobson, R.N.,C.P.N.P.
- Pediatric Nurse Practitioner
- Mesa, AZ
National Provider Identifier
1386610822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R.N.042819 PNP124
- Practice address
- 2152 S Vineyard
Suite 129
Mesa, AZ 85210-6871 - Phone
- (480) 732-0044
- Fax
- (480) 732-9333
- NPI assigned
- Feb 24, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R.N.042819 PNP124 | AZ | Primary |
Addresses
Primary practice location
2152 S Vineyard
Suite 129
Mesa, AZ 85210-6871
Mailing address
2152 S Vineyard
Suite 129
Mesa, AZ 85210-6871
Phone (480) 732-0044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431528 | Medicaid | AZ |
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
- Credentials
- Certified Pediatric Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R.N.042819 PNP124 | AZ | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1386610822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2152 S VINEYARD",
"address_2": "SUITE 129",
"city": "MESA",
"state": "AZ",
"postal_code": "852106871",
"telephone_number": "480-732-0044",
"fax_number": "480-732-9333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2152 S VINEYARD",
"address_2": "SUITE 129",
"city": "MESA",
"state": "AZ",
"postal_code": "852106871",
"telephone_number": "480-732-0044",
"fax_number": "480-732-9333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "DIANA",
"middle_name": "LYNN",
"credential": "R.N.,C.P.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-24",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AZ",
"license": "R.N.042819 PNP124",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "431528",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.