Individual
ELOISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
219 PRINCETON RD, JOHNSON CITY, TN 37601-2052
(423) 975-2200
(423) 975-2210
Mailing address
219 PRINCETON RD, JOHNSON CITY, TN 37601-2052
(423) 975-2200
(423) 975-2210
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
90697
TN
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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