Provider Demographics
NPI:1982811147
Name:JACOBSEN, KIM KRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:KRISTINE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2525
Mailing Address - Country:US
Mailing Address - Phone:305-751-0091
Mailing Address - Fax:305-751-2211
Practice Address - Street 1:5454 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2525
Practice Address - Country:US
Practice Address - Phone:305-751-0091
Practice Address - Fax:305-751-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice