Individual
MS. ANGELIQUE MECHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APN-BC
Contact information
Practice address
1410 TROTWOOD AVE, COLUMBIA, TN 38401-4901
(678) 754-7728
Mailing address
3425 MAPLE TIMBER DR, ANTIOCH, TN 37013-5453
(678) 754-7728
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
16345
TN
Other
Enumeration date
12/16/2011
Last updated
01/13/2014
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