Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Connelly

Individual provider Registered Nurse · NPI 1790147593

Jacob Connelly is a Nurse Practitioner in Los Alamos, New Mexico. Qualified in 2019, 7 years ago. Works from 3 locations. Licensed in Florida.

Years since qualifying
7
Licensed in
FL
In the registry since
2016
Specialties on file
2

Practice location Address checks out

3917 W Rd Ste A3917
Los Alamos, NM 87544-2275
Phone: (505) 661-8959
Fax: (505) 661-8916
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 737 Cape Coral Pkwy E, Cape Coral, FL 33904-8551 — (239) 542-0512
  • 8291 Dani Dr Ste 100, Fort Myers, FL 33966-8021 — (239) 931-6049

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 11005429 (FL)
Registered Nurse Taxonomy 163W00000X · Licence RN 9409391 (FL)

Record details

NPI number1790147593
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 22, 2016
Last updated in NPPESAugust 26, 2025
Certification dateAugust 26, 2025
Mailing address3917 West Rd Ste A, Los Alamos, NM 87544-2292

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Los Alamos