Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME124020 | FL |
NPI | 1073873907 |
---|---|
Provider Name | Laura Jacobsen |
First Address | Gainesville, FL 32610-0001 |
Second Address | Gainesville, FL 32610-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 10/08/2015 |