Provider Demographics
NPI:1699855106
Name:JACOBY, JEANNE MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:JACOBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:RESTIVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7000
Mailing Address - Fax:781-744-5348
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY HOSPITAL & MEDICAL CENTER
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-7000
Practice Address - Fax:781-744-5348
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH055219-23-03363LF0000X
MARN260920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084016AMedicaid
MA110084016AMedicaid