Provider Demographics
NPI:1316345234
Name:JACOBS, JULIE MARIE (APN-CNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3462
Mailing Address - Country:US
Mailing Address - Phone:847-284-3883
Mailing Address - Fax:844-530-2803
Practice Address - Street 1:5514 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3462
Practice Address - Country:US
Practice Address - Phone:847-284-3883
Practice Address - Fax:844-530-2803
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002220363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health