Provider Demographics
NPI:1245459684
Name:JACOBSON, KRISTINE ELIZABETH (APRN-CNS/CNP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:JACOBSON
Suffix:
Gender:
Credentials:APRN-CNS/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1806
Mailing Address - Country:US
Mailing Address - Phone:330-322-0130
Mailing Address - Fax:
Practice Address - Street 1:201 5TH ST NE STE 16
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3017
Practice Address - Country:US
Practice Address - Phone:330-615-3070
Practice Address - Fax:234-312-2427
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.09037364SA2100X, 364SC0200X, 364SN0800X
OHAPRN.CNP.0032224363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
No364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNS.09037OtherAPRN LICENSE
OHAPRN.CNP.0032224OtherAPRN LICENSE
OHRN 301174OtherRN LICENSE