Provider Demographics
NPI:1114044120
Name:JACOBSON, MARINA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4449
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4449
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:
Practice Address - Street 1:1801 S 5TH ST STE 130
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2915
Practice Address - Country:US
Practice Address - Phone:956-687-7863
Practice Address - Fax:956-687-6405
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01836363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical