Provider Demographics
NPI:1720385131
Name:JACOBSEN, ELIZABETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8111 DODGE ST
Mailing Address - Street 2:SUITE 363
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4129
Mailing Address - Country:US
Mailing Address - Phone:402-354-8155
Mailing Address - Fax:402-354-8159
Practice Address - Street 1:8111 DODGE ST
Practice Address - Street 2:SUITE 363
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4129
Practice Address - Country:US
Practice Address - Phone:402-354-8155
Practice Address - Fax:402-354-8159
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical