Provider Demographics
NPI:1770695009
Name:JACOBS, JANE (EDD CNS RXN)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:EDD CNS RXN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 E MONUMENT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1019
Mailing Address - Country:US
Mailing Address - Phone:719-471-8208
Mailing Address - Fax:719-389-0464
Practice Address - Street 1:130 E MONUMENT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1019
Practice Address - Country:US
Practice Address - Phone:719-471-8208
Practice Address - Fax:719-389-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30905363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health