Individual
SUYAPA MARIEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1523 PADOVA AVE, TONTITOWN, AR 72762-5386
(601) 209-9031
Mailing address
1523 PADOVA AVE, TONTITOWN, AR 72762-5386
(601) 209-9031
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
906658
MS
363LG0600X
Gerontology Nurse Practitioner
906658
MS
363LP2300X
Primary Care Nurse Practitioner
Primary
906658
MS
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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