Provider Demographics
NPI:1295966885
Name:JACOBSEN, DANIEL R (MS, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:JACOBSEN
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Gender:M
Credentials:MS, FNP-BC
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Mailing Address - Street 1:225 COMMUNITY DR
Mailing Address - Street 2:SOUTH ENTRANCE
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5506
Mailing Address - Country:US
Mailing Address - Phone:516-466-1980
Mailing Address - Fax:516-466-1954
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:SOUTH ENTRANCE
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5506
Practice Address - Country:US
Practice Address - Phone:516-466-1980
Practice Address - Fax:516-466-1954
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2010-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY401484-1163W00000X
NY336009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse