Individual
CHARLENE MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1000 W BROADWAY ST STE 214, OVIEDO, FL 32765-9262
(407) 359-5693
Mailing address
12564 HIDDEN GARDENS LN, JACKSONVILLE, FL 32258-3496
(904) 262-6120
(904) 262-6120
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
RN9237888
FL
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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