Individual
DARIAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6610 E FOWLER AVE, TEMPLE TERRACE, FL 33617-2443
(813) 377-5836
Mailing address
6610 E FOWLER AVE, TEMPLE TERRACE, FL 33617-2443
(813) 377-5836
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CL1228030
FL
Other
Enumeration date
08/25/2018
Last updated
08/25/2018
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