Individual
MRS. BERNICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
212 5TH AVE, BAY SHORE, NY 11706-6408
(718) 299-7295
Mailing address
680 ROUTE 211 E STE 3B367, MIDDLETOWN, NY 10941-1757
(914) 882-0618
(914) 919-1092
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
310387
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
405214
NY
Other
Enumeration date
09/04/2021
Last updated
05/29/2025
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