Individual
LATOSHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10603 JUNIPER BRANCH DR, ROSHARON, TX 77583-4216
(510) 853-4896
Mailing address
10603 JUNIPER BRANCH DR, ROSHARON, TX 77583-4216
(510) 853-4896
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1180974
TX
Other
Enumeration date
02/25/2025
Last updated
02/26/2025
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