Individual
DR. CAROLINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2470 BLOOMINGDALE AVE STE 260, VALRICO, FL 33596-6403
(813) 725-7220
(813) 725-7221
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2854
TN
207Q00000X
Family Medicine Physician
Primary
OS12374
FL
207Q00000X
Family Medicine Physician
UO3361
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023417500
—
FL
01
—
HJ9SR
BCBS
FL
01
—
L4606
MEDICARE
FL
Enumeration date
04/24/2013
Last updated
01/09/2024
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