Individual
MS. DIANE REGINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1248 E HILLSBOROUGH AVE, 221, TAMPA, FL 33604-7201
(813) 516-0679
Mailing address
27038 SEA BREEZE WAY, ZEPHYRHILLS, FL 33544-6617
(813) 516-0679
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
ARNP2121402
FL
364SA2200X
Adult Health Clinical Nurse Specialist
ARNP2121402
FL
Other
Enumeration date
11/19/2012
Last updated
11/20/2014
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