Organization
DYNAMIC FAMILY HEALTH NP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICKOLAS NATHANIEL JACKSON FNP-C (OWNER)
(347) 759-9040
Entity
Organization
Contact information
Practice address
611 MEDFORD AVE, EAST PATCHOGUE, NY 11772-1307
(929) 519-4039
Mailing address
13471 BEDELL ST, JAMAICA, NY 11434-4551
(347) 759-9040
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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