Provider Demographics
NPI:1164670923
Name:JACOBSON, TAO NAN CHIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAO NAN
Middle Name:CHIA
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 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0469
Mailing Address - Fax:
Practice Address - Street 1:1337 BLUE VALLEY DR STE 8
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1815
Practice Address - Country:US
Practice Address - Phone:610-654-1230
Practice Address - Fax:610-654-1232
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1084212OtherNCCPA
PAOA002319OtherOSTEOPATHIC PHYSICIAN ASSISTANT
PAMA053658OtherMEDICAL PHYSICIAN ASSISTANT