Provider Demographics
NPI:1003628447
Name:MIHKELSON, JACOB PHILLIP
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:PHILLIP
Last Name:MIHKELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:PHILLIP
Other - Last Name:MIHKELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11272 PEMBERTON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3023
Mailing Address - Country:US
Mailing Address - Phone:562-370-4638
Mailing Address - Fax:
Practice Address - Street 1:461 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37240-1104
Practice Address - Country:US
Practice Address - Phone:562-370-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95381885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse