Provider Demographics
NPI:1932386430
Name:JACOBSON, ANNELIESE (PA)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5104
Mailing Address - Country:US
Mailing Address - Phone:828-437-6500
Mailing Address - Fax:828-438-0836
Practice Address - Street 1:503 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5104
Practice Address - Country:US
Practice Address - Phone:828-437-6500
Practice Address - Fax:828-438-0836
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1075995363AS0400X
NC0010-01271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical