Individual
MR. RUSSELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2433 ADAMS LAKE BLVD, JACKSONVILLE, FL 32221-2832
(318) 404-9501
Mailing address
2433 ADAMS LAKE BLVD, JACKSONVILLE, FL 32221-2832
(318) 404-9501
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
J2507244020
FL
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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