Provider Demographics
NPI:1033459250
Name:JACOBS, SARAH (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EAST WENTWORTH AVE
Mailing Address - Street 2:SUITE 275D
Mailing Address - City:WEST ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:612-699-4629
Mailing Address - Fax:612-213-0601
Practice Address - Street 1:33 EAST WENTWORTH AVE
Practice Address - Street 2:SUITE 275D
Practice Address - City:WEST ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:612-699-4629
Practice Address - Fax:612-213-0601
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN216044-3363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health