Individual
DR. GRACE NIGHTINGALE CORTEZ JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3445 EXECUTIVE CENTER DRIVE, SUITE 250, AUSTIN, TX 78731-1678
(512) 579-4000
(512) 439-2814
Mailing address
3445 EXECUTIVE CENTER DRIVE, SUITE 250, AUSTIN, TX 78731-1678
(512) 579-4000
(512) 439-2814
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
BP1-0016584
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
N1690
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204459601
—
TX
Enumeration date
06/14/2007
Last updated
10/15/2014
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