Provider Demographics
NPI:1407026446
Name:JACOBS, ROSEMARY (MSN FNP BC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 WILKINSVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1537
Mailing Address - Country:US
Mailing Address - Phone:901-872-3114
Mailing Address - Fax:901-872-3116
Practice Address - Street 1:8510 WILKINSVILLE RD
Practice Address - Street 2:104
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-872-3114
Practice Address - Fax:901-872-3114
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1700227436OtherGROUP NPI
TN1513105Medicaid