Brianne Jacobson, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601002314 Issued in MI

Practice address

4001 W McNichols Rd
Detroit, MI 48221-3038

Phone

(435) 659-0849

NPI assigned

Mar 26, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1922635093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 PARK AVE STE 4403",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605148",
            "telephone_number": "435-659-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213038",
            "telephone_number": "435-659-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "BRIANNE",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601002314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaisy Jacob
• Sony Jacob, MD
• Kenneth Allen Jacobs, PHARMD
• Rachel Jacobs, CPSS
• Starlecia Jacobs
• Lilly Glancy Jacobson, PH.D.
• Teresa Ann Jacobson, NBC-HWC
• William Dean Jacobus, DO
• Jacqueline Phillips DPM Inc
• Jacqueline Phillips DPM Inc

• Athletic Trainer in Detroit, MI
• Providers in Detroit, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.