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Individual
TANAGRA JACKSON
Active
Individual
TANAGRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95021964
CA
363LF0000X
Family Nurse Practitioner
Primary
32937
TN
363LF0000X
Family Nurse Practitioner
95021964
CA
Other
Enumeration date
09/22/2022
Last updated
08/25/2026
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