Provider Demographics
NPI:1073589834
Name:JACOBSEN, PAULA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:2955 BROWNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2039
Practice Address - Country:US
Practice Address - Phone:844-884-9355
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000441363LF0000X
IAA-127382363LF0000X
FLAPRN11003740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN37L32SAOtherCC SYSTEMS/ BLUE PLUS
769201045265OtherPREFERRED ONE
MN37L32SAOtherBLUE CROSS
1073589834OtherARAZ/AMERICA'S PPO
SD57105F019OtherWPS TRICARE
SD9237791OtherDAKOTACARE
IA0596684Medicaid
P00448581OtherRR MEDICARE
SD102157Medicaid
ND12262Medicaid
SD4992623OtherBLUE CROSS
SD6828076Medicaid
1073589834OtherARAZ/AMERICA'S PPO
SD6828076Medicaid
SDS102830Medicare PIN