Individual
ANNA PAVLOVNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
11327 OKEECHOBEE BLVD, STE 2 & 3, MEDICAL MALL 2, SUITE 224, LOXAHATCHEE, FL 33470
(561) 340-1615
(561) 340-4026
Mailing address
11327 OKEECHOBEE BLVD, STE 2 & 3, LOXAHATCHEE, FL 33470
(561) 340-1615
(561) 340-4026
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
APRB11004601
FL
363LP0200X
Pediatric Nurse Practitioner
11004601
FL
Other
Enumeration date
10/25/2019
Last updated
11/06/2023
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