Individual
NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP
Contact information
Practice address
200 BANNING ST STE 260, DOVER, DE 19904-3489
(302) 224-1400
(302) 224-1402
Mailing address
200 BANNING ST STE 260, DOVER, DE 19904-3489
(302) 224-1400
(302) 224-1402
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
LG0001029
DE
363LF0000X
Family Nurse Practitioner
LG0001029
DE
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
L80010226
DE
Other
Enumeration date
03/28/2017
Last updated
02/20/2023
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