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Individual
STEFANIE M JACKSON
Active
Individual
STEFANIE M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP 2620432
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
275262
AVMED
FL
01
—
363L00000X
TAXONOMY CODE
FL
01
—
ARNP2620432
MEDICAL LICENSE
FL
01
—
DE000Z
MEDICARE PTAN
FL
Enumeration date
04/14/2006
Last updated
06/25/2010
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