Individual
EDWIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4010 CENTRAL AVE, ST PETERSBURG, FL 33711-1239
(727) 327-7656
(727) 388-1192
Mailing address
4024 CENTRAL AVE, ST PETERSBURG, FL 33711-1239
(727) 327-7656
(727) 388-1192
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME 87406
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME 87406
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F01714
FLORIDA HEALTH PARTNERS
FL
Enumeration date
07/27/2006
Last updated
10/10/2011
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