Provider Demographics
NPI:1336376128
Name:JACOBSON, LYNNE MARIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 COUNTY ROAD 9 S
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9610
Mailing Address - Country:US
Mailing Address - Phone:719-589-3671
Mailing Address - Fax:
Practice Address - Street 1:8745 COUNTY ROAD 9 S
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9610
Practice Address - Country:US
Practice Address - Phone:719-589-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107198163W00000X
CONP10040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO107198OtherRN
CO32658044Medicaid
COCOA101700Medicare PIN
COCOA108795Medicare PIN