Individual
HEIDI A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
261 N ROOSEVELT AVE, CHANDLER, AZ 85226-2616
(480) 305-2888
(480) 305-2889
Mailing address
158 N MAIN ST, PO BOX 299, FLORIDA, NY 10921-1133
(845) 651-1400
(845) 651-1510
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F332937
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510793
RN
—
Enumeration date
10/28/2006
Last updated
03/07/2023
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