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Individual
MRS. NICOLE S JACKSON
Active
Individual
MRS. NICOLE S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F334631 1
NY
363LF0000X
Family Nurse Practitioner
Primary
RN277697
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02733026
—
NY
Enumeration date
09/24/2007
Last updated
01/16/2025
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