Provider Demographics
NPI:1982982344
Name:JACOBS, LAURA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-586-8200
Mailing Address - Fax:859-586-8233
Practice Address - Street 1:6159 1ST FINANCIAL DR
Practice Address - Street 2:ST. ELIZABETH PHYSICIANS
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7892
Practice Address - Country:US
Practice Address - Phone:859-586-8200
Practice Address - Fax:859-586-8233
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100175190Medicaid
KYK013420Medicare PIN