Provider Demographics
NPI:1871537076
Name:JACOBSEN, MARY KAY (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 23RD STREET SOUTH
Mailing Address - Street 2:APT. 901
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3761
Mailing Address - Country:US
Mailing Address - Phone:703-418-2392
Mailing Address - Fax:
Practice Address - Street 1:2000 NAVY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20350-2000
Practice Address - Country:US
Practice Address - Phone:703-614-2366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3100292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily