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Tate Jacobson
NPI 1679288344 · on the registry since 2023
Practice
- Address
- 4422 E State Blvd
Fort Wayne, IN 46815 - Phone
- (260) 471-9263
- Fax
- (317) 520-8200
- Clinicians at this address
- 374
Additional practice sites
- 201 E Rudisill Blvd Ste 100b, Fort Wayne, IN
Registry record
- Primary taxonomy
- 103K00000X
103K00000X
- Also registered as
- 106S00000X
- Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-09-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana