Provider Demographics
NPI:1003353673
Name:MORRISON, JACOB ANDREW
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ANDREW
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1324
Mailing Address - Country:US
Mailing Address - Phone:717-533-7850
Mailing Address - Fax:717-533-8294
Practice Address - Street 1:441 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1324
Practice Address - Country:US
Practice Address - Phone:717-533-7850
Practice Address - Fax:717-533-8294
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017133363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics