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Individual
NICOLE STANLEY JACKSON
Active
Individual
NICOLE STANLEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN143548
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0414179
AMERICAN ACADEMY OF NURSE PRACTITIONERS
GA
01
—
RN143548
GEORGIA SECRETARY OF STATE
GA
Enumeration date
07/07/2014
Last updated
10/24/2023
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