Individual
MRS. JAMIE CRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1675 TRINITY DR, PENSACOLA, FL 32504-5708
(850) 416-7710
(850) 416-6729
Mailing address
PO BOX 2699, PENSACOLA, FL 32513-2699
(850) 475-4686
(850) 475-4619
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
121872
FL
208000000X
Pediatrics Physician
MD.203018
LA
2080C0008X
Child Abuse Pediatrics Physician
121872
FL
2080C0008X
Child Abuse Pediatrics Physician
MD.203018
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023386100
—
FL
05
—
1457299
—
LA
Enumeration date
03/07/2008
Last updated
04/25/2018
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