Individual
MISS CARMEN RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, FNP-BC
Contact information
Practice address
1005 N LAKE PARKER AVE, LAKELAND, FL 33805-4723
(863) 583-4053
Mailing address
418 EUCLID AVE APT 4B, MIAMI BEACH, FL 33139-6526
(305) 726-4727
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP935595
FL
Other
Enumeration date
01/31/2018
Last updated
03/06/2018
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