Individual
REGINA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4094 LAFAYETTE ST, MARIANNA, FL 32446-5648
(850) 482-7441
Mailing address
4300 CENTURY RD, GREENWOOD, FL 32443-1928
(254) 426-8975
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1240831
FL
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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