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Organization
LETICIA JACKSON PA
Active
Organization
LETICIA JACKSON PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETICIA JACKSON ARNP (PRESIDENT)
(786) 624-9333
Entity
Organization
Contact information
Practice address
12973 SW 112TH ST, SUITE 144, MIAMI, FL 33186-4768
(786) 624-9333
Mailing address
12973 SW 112TH ST, SUITE 144, MIAMI, FL 33186-4768
(786) 624-9333
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP3326732
FL
Other
Enumeration date
05/28/2014
Last updated
05/28/2014
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