Individual
MRS. MELODY FELISSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-5143
Mailing address
21150 NE MIAMI CT, MIAMI GARDENS, FL 33179-1033
(305) 585-5143
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
211763
FL
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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