Individual
MARY TIFFANY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1300 ENTERPRISE DR, LYNCHBURG, VA 24502-5746
(434) 845-6045
Mailing address
4110 BALL PARK LOOP, HALIFAX, VA 24558-2222
(540) 312-5256
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024195024
VA
Other
Enumeration date
10/17/2025
Last updated
01/28/2026
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