Individual
MRS. TONDA P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4100 N MAIN ST STE 102, COLUMBIA, SC 29203-5800
(803) 223-9895
(803) 735-3641
Mailing address
6255 W SUNSET BLVD FL 21, LOS ANGELES, CA 90028-7422
(323) 860-5200
(323) 467-7119
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN883
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0831
—
SC
Enumeration date
02/28/2006
Last updated
05/06/2024
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