Provider Demographics
NPI:1780041301
Name:JACOBI, NICOLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:JACOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-8693
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2774
Practice Address - Country:US
Practice Address - Phone:763-712-2100
Practice Address - Fax:763-712-2190
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN60242207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology