Provider Demographics
NPI:1659435600
Name:JACOBSON, LINDA A (APRN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3019
Mailing Address - Country:US
Mailing Address - Phone:203-248-8888
Mailing Address - Fax:203-248-8889
Practice Address - Street 1:451 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3019
Practice Address - Country:US
Practice Address - Phone:203-248-8888
Practice Address - Fax:203-248-8889
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000895363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035017Medicaid