Provider Demographics
NPI:1336125855
Name:JACOBSON, THOMAS ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALAN
Last Name:JACOBSON
Suffix:
Gender:M
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:COAST GUARD HQ (CG-1122)
Mailing Address - Street 2:2100 SECOND STREET SW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-269-0801
Mailing Address - Fax:
Practice Address - Street 1:COAST GUARD HQ (CG-1122)
Practice Address - Street 2:2100 SECOND STREET SW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-269-0801
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1033334 (NCCPA)363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical