Provider Demographics
NPI:1184441602
Name:JACOBSON, CANDY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:WORMSBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2721 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1651
Mailing Address - Country:US
Mailing Address - Phone:701-509-4573
Mailing Address - Fax:
Practice Address - Street 1:2721 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1651
Practice Address - Country:US
Practice Address - Phone:701-509-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND200987261QP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care