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Individual

PATRICE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1985 MARCUS AVE, NEW HYDE PARK, NY 11042-2008
(473) 789-8983
Mailing address
1985 MARCUS AVE, NEW HYDE PARK, NY 11042-2008
(347) 378-9898

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
310015
NY

Other

Enumeration date
11/17/2020
Last updated
06/27/2023
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