Provider Demographics
NPI:1902689425
Name:JACOBS, YONATON A (ARNP)
Entity type:Individual
Prefix:
First Name:YONATON
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S 348TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7042
Mailing Address - Country:US
Mailing Address - Phone:253-382-8540
Mailing Address - Fax:253-661-4286
Practice Address - Street 1:710 S 348TH ST STE A
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7042
Practice Address - Country:US
Practice Address - Phone:253-382-8540
Practice Address - Fax:253-661-4286
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60172888163W00000X
WAAP61588691363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2299978Medicaid