Provider Demographics
NPI:1942246392
Name:JACOBSEN, NOELLE (CNM, PMHNP-C WHNP-BC)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:CNM, PMHNP-C WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE STE N
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0581
Mailing Address - Country:US
Mailing Address - Phone:206-207-7547
Mailing Address - Fax:206-339-1448
Practice Address - Street 1:200 MAITLAND AVE APT 142
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5539
Practice Address - Country:US
Practice Address - Phone:206-207-7547
Practice Address - Fax:206-339-1448
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-5219363LP0808X
FLAPRN9214204363LP0808X
AK231955363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
104896769OtherNATIONAL CERTIFICATION CORPORATION (NCC) FOR WHNP-BC
FL306777700Medicaid
FL259038700Medicaid
11445OtherACNM CERTIFICATION COUNCIL CERTIFIED NURSE MIDWIFE
PMH10240017OtherAMERICAN ASSOCIATION OF NURSE PRACTITIONERS (AANP) FOR PMHNP-C
24039Medicare ID - Type Unspecified