Individual
JOHN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
127 TALLULAH AVE, JACKSONVILLE, FL 32208-4163
(904) 707-1943
Mailing address
127 TALLULAH AVE, JACKSONVILLE, FL 32208-4163
(904) 707-1943
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347E00000X
Transportation Broker
—
—
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
FL
374U00000X
Home Health Aide
—
—
Other
Enumeration date
10/30/2020
Last updated
01/14/2021
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