Organization
HYDRATION HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA JACKSON APRN (OWNER)
(786) 290-5415
Entity
Organization
Contact information
Practice address
5600 NW 57TH WAY, TAMARAC, FL 33319-2420
(786) 290-5415
Mailing address
5600 NW 57TH WAY, TAMARAC, FL 33319-2420
(786) 290-5415
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/05/2021
Last updated
02/05/2021
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