Provider Demographics
NPI:1174729149
Name:JACOBSON, FRANCINE
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:CRUZ BAY
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00831-0735
Mailing Address - Country:US
Mailing Address - Phone:340-693-8642
Mailing Address - Fax:
Practice Address - Street 1:MORRIS DECASTRO CLINIC
Practice Address - Street 2:CRUZ BAY
Practice Address - City:ST. JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830
Practice Address - Country:US
Practice Address - Phone:340-693-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI5138261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health