Provider Demographics
NPI:1194559773
Name:JACOBSEN, KRISTINA (CNP, RN, PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:CNP, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2303 WYCLIFF ST STE 313
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1278
Mailing Address - Country:US
Mailing Address - Phone:651-401-6677
Mailing Address - Fax:651-401-6677
Practice Address - Street 1:2303 WYCLIFF ST STE 313
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1278
Practice Address - Country:US
Practice Address - Phone:651-401-6677
Practice Address - Fax:651-401-6677
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN13374363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health