Individual
MS. MILDRED JEAN LEE-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
178 HOWARD ST, NICEVILLE, FL 32578-8022
(850) 678-6436
Mailing address
178 HOWARD ST, NICEVILLE, FL 32578-8022
(850) 678-6436
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT0003333
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891638100
—
FL
Enumeration date
04/29/2008
Last updated
04/29/2008
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