Individual
MRS. TIFFANY R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1108 W STATE ST, SUITE 3, HASTINGS, MI 49058-9711
(269) 945-0922
(269) 945-4511
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704240163
MI
Other
Enumeration date
10/01/2012
Last updated
09/13/2016
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