Provider Demographics
NPI:1285032201
Name:JACOBS, KRISTEN (APRN CNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
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 1:1277 SOM CENTER RD # LOFT9
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2050
Mailing Address - Country:US
Mailing Address - Phone:440-840-2093
Mailing Address - Fax:
Practice Address - Street 1:1277 SOM CENTER ROAD, LOFT 9
Practice Address - Street 2:LOFT 9
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4412
Practice Address - Country:US
Practice Address - Phone:440-840-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026506363LF0000X
OHAPRN.CNP.026506363LF0000X
OHRN404818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse