Provider Demographics
NPI:1801293899
Name:JACOBS, JENNIFER COLLEEN FLAVIN (MPAS, PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:COLLEEN FLAVIN
Last Name:JACOBS
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Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:4150 NELSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4148
Mailing Address - Country:US
Mailing Address - Phone:337-656-7940
Mailing Address - Fax:337-761-4673
Practice Address - Street 1:4150 NELSON RD STE 1
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4148
Practice Address - Country:US
Practice Address - Phone:337-656-7940
Practice Address - Fax:337-761-4673
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2024-05-09
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Provider Licenses
StateLicense IDTaxonomies
LA200769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant