Individual
RUTH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 SWAIN BLVD, GREENACRES, FL 33463
(561) 635-5130
Mailing address
225 SWAIN BLVD, GREENACRES, FL 33463
(561) 635-5130
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
081972
FL
171W00000X
Contractor
091972
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091972
APD
FL
Enumeration date
10/01/2021
Last updated
10/01/2021
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