Individual
GLORIA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
900 MEDICAL CENTER DR STE 200, SEWELL, NJ 08080-2358
(856) 557-7900
Mailing address
3400 CIVIC CENTER BLVD, PCAM 4 WEST, PHILADELPHIA, PA 19104
(215) 615-5858
(215) 349-8144
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ00058800
NJ
363L00000X
Nurse Practitioner
SP007231
PA
Other
Enumeration date
03/27/2007
Last updated
12/11/2019
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