Individual
MS. ANISHA NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5 HUTTON CENTRE DR STE 950, SANTA ANA, CA 92707-8744
(855) 434-7763
Mailing address
461 TENNESSEE ST STE C, REDLANDS, CA 92373-8161
(217) 416-2021
(217) 569-4332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
56906
CA
405300000X
Prevention Professional
56906
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174760961
—
CA
01
—
56906
STATE CA LICENSE
CA
Enumeration date
01/15/2009
Last updated
10/04/2025
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