Individual
MS. TERI LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
60 W GORE ST, ORLANDO, FL 32806-1141
(321) 841-3338
(321) 841-2170
Mailing address
60 W GORE ST, ORLANDO, FL 32806-1141
(321) 841-3338
(321) 841-2170
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP3131802
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001951500
—
FL
01
—
ARNP3131802
MEDICAL LICENSE
FL
Enumeration date
08/20/2006
Last updated
11/14/2016
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