Individual
ANCELLE MAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
774 HIGHWAY 96, BONAIRE, GA 31005-3300
(478) 988-5711
Mailing address
1428 RIDGE BROOK TRL, DULUTH, GA 30096-6810
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11000926
FL
363LF0000X
Family Nurse Practitioner
Primary
RN300851
GA
Other
Enumeration date
01/14/2019
Last updated
10/13/2025
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