Individual
KIMCHEREE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8645
Mailing address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8645
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9250679
FL
Other
Enumeration date
05/20/2015
Last updated
04/30/2020
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