Provider Demographics
NPI:1609344464
Name:JACOBSEN, JAMI MARY ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:MARY ELIZABETH
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 E FLORENCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4788
Mailing Address - Country:US
Mailing Address - Phone:520-635-5318
Mailing Address - Fax:
Practice Address - Street 1:1550 E FLORENCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4788
Practice Address - Country:US
Practice Address - Phone:520-483-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219044363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily