Organization
J&E JACKSON ENTERPRISES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILY JACKSON DPM (PHYSICIAN)
(321) 704-1807
Entity
Organization
Contact information
Practice address
1677 EAGLE HARBOR PKWY # C, FLEMING ISLAND, FL 32003-4802
(904) 278-5112
Mailing address
1677 EAGLE HARBOR PKWY # C, FLEMING ISLAND, FL 32003-4802
(904) 278-5112
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
PO3484
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FD5660
MEDICARE PTAN
FL
Enumeration date
07/29/2015
Last updated
02/12/2018
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