Provider Demographics
NPI:1023038726
Name:JACOBSON, KRISTINA (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
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 1:12865 POINTE DEL MAR WAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-350-7546
Mailing Address - Fax:858-350-7501
Practice Address - Street 1:12865 POINTE DEL MAR WAY
Practice Address - Street 2:SUITE 160
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-350-7546
Practice Address - Fax:858-350-7501
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP39164Medicare UPIN