Individual
ANDREA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10040 HILLVIEW DR, PENSACOLA, FL 32514-5499
(850) 607-6024
Mailing address
10040 HILLVIEW DR, PENSACOLA, FL 32514-5499
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PTA 21106
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314000000X
—
FL
Enumeration date
05/07/2014
Last updated
05/07/2014
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