Renee Rose Jacobson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704147470 Issued in MI

Practice address

3335 S Airport Rd W Ste 7B
Traverse City, MI 49684-7928

Phone

(231) 463-1611

Fax

(231) 947-1284

NPI assigned

Apr 24, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Renee Rose Jacobson Professional name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Northwestern Michigan College

  • Student Health Clinic/Center
  • Traverse City, MI
  • NPI 1700033859
  NPD (past) Authorized official

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1619196490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3335 S AIRPORT RD W STE 7B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847928",
            "telephone_number": "231-463-1611",
            "fax_number": "231-947-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3335 S AIRPORT RD W STE 7B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847928",
            "telephone_number": "231-463-1611",
            "fax_number": "231-947-1284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "RENEE",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704147470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "JACOBSON",
            "middle_name": "ROSE",
            "prefix": "MRS.",
            "credential": "NURSE PRACTITIONER",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sarah Kristen Jackson, MS
• Jacob White PH.D., PLLC
• Katelyn Jacobs, OTRL
• Matthew Jacobs
• Paul Anders Jacobson, M.D.
• Jacqueline Keller Counseling PLLC
• Candis Jade
• Brian D Jaffe, M.D.
• Alexis Nicole Jaggi, PA
• Rebecca Jahn, CRNA

• All providers in Traverse City, MI
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.