Individual
CAROLYN L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
(210) 358-4911
Mailing address
7703 FLOYD CURL DR, MC7977, SAN ANTONIO, TX 78229-3901
(210) 450-4000
(210) 450-4903
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
745549
TX
367500000X
Certified Registered Nurse Anesthetist
RN 160197
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186606302
—
TX
Enumeration date
02/05/2007
Last updated
04/01/2011
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