Individual
ANQUANETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 S RIDGEWOOD AVE, SOUTH DAYTONA, FL 32119-3097
(305) 928-0167
Mailing address
579 LAGORCE TER, DELTONA, FL 32738-8973
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/20/2017
Last updated
03/17/2018
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