Individual
TAIWAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2510 S OAK AVE STE C, SANFORD, FL 32773-4100
(407) 864-5534
Mailing address
2510 S OAK AVE STE C, SANFORD, FL 32773-4100
(407) 864-5534
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5241013
FL
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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