Provider Demographics
NPI:1134105950
Name:JACOBI, DEBORAH ANN (PNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:JACOBI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:JACOBI-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2311
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-933-2263
Practice Address - Fax:602-933-4256
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381056363LP0200X
AZAP9775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235781Medicaid
NY00027129401OtherUNIVERA UNDER DR. K. SENN
NYCC4173Medicare PIN