Individual
ANITA JOHNSON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3204 N RIDGE RD, TALLAHASSEE, FL 32305
(786) 682-1620
Mailing address
3204 N RIDGE RD, TALLAHASSEE, FL 32305-6726
(786) 682-1620
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/14/2017
Last updated
07/21/2022
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