Provider Demographics
NPI:1548293459
Name:JACOBSON, KARL ARN (CRNA)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:ARN
Last Name:JACOBSON
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9046
Mailing Address - Country:US
Mailing Address - Phone:509-447-2441
Mailing Address - Fax:509-447-2281
Practice Address - Street 1:75-5905 WALUA RD STE 4
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-5315
Practice Address - Country:US
Practice Address - Phone:808-331-7960
Practice Address - Fax:808-331-0152
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID052277367500000X
WAAP30007570367500000X
HIAPRN-4220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID270110753OtherEIN