Provider Demographics
NPI:1184401580
Name:HORSTMAN, JACOB DEAN (PA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DEAN
Last Name:HORSTMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 FORT SIDNEY RD APT 1108
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2605
Mailing Address - Country:US
Mailing Address - Phone:308-764-7432
Mailing Address - Fax:
Practice Address - Street 1:1000 POLE CREEK XING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2901
Practice Address - Country:US
Practice Address - Phone:308-254-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant