Provider Demographics
NPI:1942813514
Name:JACOBSON, JANIS DEBRA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:DEBRA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5770
Mailing Address - Country:US
Mailing Address - Phone:951-769-0079
Mailing Address - Fax:
Practice Address - Street 1:835 HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5770
Practice Address - Country:US
Practice Address - Phone:951-769-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily