Individual
ANGELETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1901 HUGUENOT RD, SUITE 309, NORTH CHESTERFIELD, VA 23235-4311
(804) 955-4864
Mailing address
PO BOX 693, MIDLOTHIAN, VA 23113-0693
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024172629
VA
363LA2200X
Adult Health Nurse Practitioner
0024172629
VA
363LG0600X
Gerontology Nurse Practitioner
Primary
0024172629
VA
Other
Enumeration date
06/05/2015
Last updated
03/31/2022
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