Individual
MRS. SHAWANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTAL HYGIENIST
Contact information
Practice address
3250 ZEMKE AVENUE, TAMPA, FL 33621-5205
(813) 827-9400
Mailing address
3250 ZEMKE AVENUE, TAMPA, FL 33621-5205
(813) 827-9400
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
8873
SC
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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