Provider Demographics
NPI:1407992027
Name:JACOBOWITZ, PATRICIA BOURGUIGNON (RN NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:BOURGUIGNON
Last Name:JACOBOWITZ
Suffix:
Gender:F
Credentials:RN NURSE PRACTITIONE
Other - Prefix:
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Mailing Address - Street 1:21 OAKLAND STREET
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-758-8093
Mailing Address - Fax:631-758-8096
Practice Address - Street 1:21 OAKLAND STREET
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-8093
Practice Address - Fax:631-758-8096
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1702901363LP0808X
NYF4002151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health