Individual
JENNIFER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1110 BROAD AVE, STE 700, GULFPORT, MS 39501-8907
(228) 867-4580
(228) 867-4708
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 867-4580
(228) 867-4708
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R859293
MS
Other
Enumeration date
08/30/2010
Last updated
07/10/2014
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