Individual
MRS. CAROL ANNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
10710 SE 160TH COURT RD, OCKLAWAHA, FL 32179-8906
(352) 750-6619
Mailing address
10710SE160TH CT RD, OCKLAWAHA, FL 32179
(352) 804-2231
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
FLOTA8013
FL
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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