Mary A Jacobsen, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1202472 Issued in FL

Practice address

801 E 6TH St
Suite 205
Panama City, FL 32401-3661

Phone

(850) 785-3185

Fax

(850) 785-6233

NPI assigned

Jan 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912053356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E 6TH ST",
            "address_2": "SUITE 205",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013661",
            "telephone_number": "850-785-3185",
            "fax_number": "850-785-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E 6TH ST",
            "address_2": "SUITE 205",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013661",
            "telephone_number": "850-785-3185",
            "fax_number": "850-785-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "1202472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BCBS",
            "identifier": "G0435",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE",
            "identifier": "ARNP1202472",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00287820",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tameka Jackson
• Tasha Ann Jackson, LCSW
• Taveka L Jackson, MS, LMHC
• Eacharangad Ipye Jacob, MD
• Carrie Jones Jacobs
• Leanne E Jacquemin, CRNA
• James H Mullins D.M.D. PA
• Lamaras James, M.S.
• Patricia Davey James, CRNA
• Sarah Mikel James, ARNP

• Certified Registered Nurse Anesthetist in Panama City, FL
• Providers in Panama City, FL by specialty
• Certified Registered Nurse Anesthetist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.