Individual
ELMIRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S WARNER AVE APT I4, PERRY, FL 32348-5303
(850) 661-0328
Mailing address
500 S WARNER AVE APT I4, PERRY, FL 32348-5303
(850) 661-0328
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
119839
FL
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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