Provider Demographics
NPI:1760029888
Name:JACOBUS, ALEXANDRIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13126 BEALS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4596
Mailing Address - Country:US
Mailing Address - Phone:219-384-5997
Mailing Address - Fax:
Practice Address - Street 1:11212 STATE HIGHWAY 151 STE 230
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4501
Practice Address - Country:US
Practice Address - Phone:210-401-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily