Individual
JAYLEENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4140 GAUGE LINE LOOP, TAMPA, FL 33624-5130
(484) 219-7873
Mailing address
4140 GAUGE LINE LOOP, TAMPA, FL 33624-5130
(484) 219-7873
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
30878571
PA
Other
Enumeration date
05/31/2022
Last updated
06/02/2022
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