Individual
TIFFANY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
404 RIVERWIND DR STE B-1, PEARL, MS 39208-5900
(601) 623-9245
(601) 623-9246
Mailing address
PO BOX 495, JACKSON, MS 39205-0495
(601) 623-9245
(601) 623-9246
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F0115051
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07833786
—
MS
Enumeration date
03/02/2015
Last updated
04/19/2021
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