Individual
MRS. LATOYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 222-8970
Mailing address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 222-9970
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004292
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12237263
CAQH
—
Enumeration date
03/29/2007
Last updated
03/23/2026
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