Organization
JACKSON TARAVINE SR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKSON TARAVINE SR. PA (OWNER)
(786) 865-3586
Entity
Organization
Contact information
Practice address
1256 W CHANDLER BLVD STE G, CHANDLER, AZ 85224-5208
(480) 712-7108
(480) 300-5840
Mailing address
15182 N 75TH AVE STE 180, PEORIA, AZ 85381-4722
(480) 300-5798
(480) 300-5840
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/09/2025
Last updated
03/03/2026
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