Individual
MRS. TANEISHA JACSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4660 MARTIN LUTHER KING JR AVE SW STE A3, WASHINGTON, DC 20032-4958
(202) 558-4681
Mailing address
5023 36TH PL, HYATTSVILLE, MD 20782-3909
(240) 441-8441
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN1003671
DC
Other
Enumeration date
04/01/2010
Last updated
04/01/2010
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