Provider Demographics
NPI:1578136065
Name:JONES, JAKE ROBERT (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:ROBERT
Last Name:JONES
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S GARFIELD AVE STE 229
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3429
Mailing Address - Country:US
Mailing Address - Phone:623-270-0527
Mailing Address - Fax:623-399-1949
Practice Address - Street 1:801 S GARFIELD AVE STE 229
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3429
Practice Address - Country:US
Practice Address - Phone:623-270-0527
Practice Address - Fax:623-399-1949
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257653363L00000X
MI4704411604363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner