Provider Demographics
NPI:1467966473
Name:JACOBSON, MICHELLE EVELYN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:EVELYN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 HIGHLAND PARK RD
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-9736
Mailing Address - Country:US
Mailing Address - Phone:814-591-2033
Mailing Address - Fax:
Practice Address - Street 1:145 HOSPITAL AVE STE 205
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1464
Practice Address - Country:US
Practice Address - Phone:814-375-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily