# AUDREY LEE FARSON JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1114507332
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | APRN11026952 | FL | Yes |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | APRN11026952 | FL | — |

## Other

- **Enumeration date:** 04/12/2021
- **Last updated:** 02/09/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 120782400 | — | FL |
| 01 | — | SA065 | MEDICARE HF | FL |