Individual
MRS. TAMARA JEAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
350 HENRY AVE, WEWAHITCHKA, FL 32465-8766
(850) 639-6211
Mailing address
350 HENRY AVE, WEWAHITCHKA, FL 32465-8766
(850) 639-6211
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MA36032
FL
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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