Provider Demographics
NPI:1942246392
Name:JACOBSEN, NOELLE (CNM, MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:CNM, MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4616
Mailing Address - Country:US
Mailing Address - Phone:407-296-5177
Mailing Address - Fax:407-521-4699
Practice Address - Street 1:5151 RALEIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3926
Practice Address - Country:US
Practice Address - Phone:407-296-5177
Practice Address - Fax:407-521-4699
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214204367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
11445OtherACNM CERTIFICATION COUNCIL CERTIFIED NURSE MIDWIFE
FL259038700Medicaid
FL306777700Medicaid
11445OtherACNM CERTIFICATION COUNCIL CERTIFIED NURSE MIDWIFE
FL306777700Medicaid
24039Medicare ID - Type Unspecified