Tina Lynne Jacobs, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71002683A Issued in IN

Practice address

550 S Landmark Ave
Bloomington, IN 47403-3239

Phone

(812) 330-3688

Fax

(812) 355-3270

NPI assigned

Jul 15, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Indiana Clinic Critical Care LLC

  • Pulmonary Disease Physician
  • Indianapolis, IN
  • NPI 1417285230
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1457515884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N MERIDIAN ST",
            "address_2": "STE 500 - PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462043908",
            "telephone_number": "317-962-4941",
            "fax_number": "317-962-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-330-3688",
            "fax_number": "812-355-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "TINA",
        "middle_name": "LYNNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-15",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71002683A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200903450",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Sophia Lauren Jacob
• Cherish Hope Jacobs-Tuttle
• Ashton Jacobs, FNP-C
• Dinah F Jacobs, DPT
• Steven Eugene Jacobs, PA-C
• Jacqueline M Jordan LLC
• Samantha Nichole Jahnke, OD
• Manish Jain, MD
• Pravi Jain, RBT
• Sanya Jaiswal

• Nurse Practitioner in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; 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.