Individual
ANDREA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, 6 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 615-4949
Mailing address
3400 SPRUCE ST, 6 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP012594
PA
Other
Enumeration date
01/17/2013
Last updated
01/17/2013
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