Individual
TARA Y. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP SP020082
Contact information
Practice address
680 BLAIR MILL RD, HORSHAM, PA 19044-2223
(215) 902-9014
Mailing address
680 BLAIR MILL RD, HORSHAM, PA 19044-2223
(215) 902-9014
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN527439L
PA
363LF0000X
Family Nurse Practitioner
SP020082
PA
Other
Enumeration date
02/08/2019
Last updated
03/06/2019
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