Individual
TINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1 ARDEN LN APT A, EASTAMPTON, NJ 08060-3371
(800) 950-6066
Mailing address
1 ARDEN LN APT A, EASTAMPTON, NJ 08060-3371
(800) 950-6066
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP05502400
NJ
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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