Basic Information
| Provider Information | |||||||||
| NPI: | 1003026469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBSON | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13442 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787113442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123235465 | ||||||||
| FaxNumber: | 5123271390 | ||||||||
| Practice Location | |||||||||
| Address1: | 5656 BEE CAVES RD. BLDG C STE. 102 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123235465 | ||||||||
| FaxNumber: | 5123271390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N5127 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N5127 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.