Provider Demographics
NPI:1154557056
Name:JACOBSON, JODY ADELE (JODY JACOBSON, NNP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:ADELE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:JODY JACOBSON, NNP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:ADELE
Other - Last Name:DERRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JODY DERRINGTON, RN
Mailing Address - Street 1:752 APPLE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3258
Mailing Address - Country:US
Mailing Address - Phone:720-890-6165
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6857
Practice Address - Fax:720-777-7207
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP10026363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal