Individual
ANITA DIONNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 BALTIMORE LN, PALM COAST, FL 32137-8851
(386) 264-1398
(386) 303-5536
Mailing address
17 OLD KINGS RD N STE E, PALM COAST, FL 32137-8283
(386) 264-1398
(386) 303-5536
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
30212414
FL
253Z00000X
In Home Supportive Care Agency
—
FL
Other
Enumeration date
11/29/2018
Last updated
07/12/2022
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