Provider Demographics
NPI:1104456565
Name:JACOBSON, JASON ROBERT (APRN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 NATURES HAMMOCK RD N
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2891
Mailing Address - Country:US
Mailing Address - Phone:602-403-9466
Mailing Address - Fax:
Practice Address - Street 1:4241 BAYMEADOWS RD STE 16
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4674
Practice Address - Country:US
Practice Address - Phone:602-403-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003000363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner