Individual
MR. CARNEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-2040
(585) 275-0980
Mailing address
978 CLINTON AVE S, ROCHESTER, NY 14620-2040
(585) 576-1001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
342660
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
342660
—
NY
Enumeration date
07/10/2015
Last updated
06/29/2023
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