Individual
STACIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3627 UNIVERSITY BLVD S STE 550, JACKSONVILLE, FL 32216-7401
(904) 379-5986
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9115246
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9115246
FL
Other
Enumeration date
11/04/2021
Last updated
03/10/2025
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