Provider Demographics
NPI:1396918462
Name:JACOBS-PETERSON, LU ANN (APRN FNP)
Entity type:Individual
Prefix:
First Name:LU ANN
Middle Name:
Last Name:JACOBS-PETERSON
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14540 S MAJESTIC OAKS LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3645
Mailing Address - Country:US
Mailing Address - Phone:801-232-1998
Mailing Address - Fax:
Practice Address - Street 1:2376 N 400 E STE 205
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:435-882-8111
Practice Address - Fax:435-882-2111
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT219855-4405363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily