Provider Demographics
NPI:1336702646
Name:JACOBSEN, HANNAH (PA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:AGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3490 CALIFORNIA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1892
Mailing Address - Country:US
Mailing Address - Phone:415-593-1134
Mailing Address - Fax:
Practice Address - Street 1:3490 CALIFORNIA ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1892
Practice Address - Country:US
Practice Address - Phone:415-593-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA56894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program