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Individual

JERINA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9550 US HIGHWAY 19 STE 202, PORT RICHEY, FL 34668-4648
(727) 494-7609
Mailing address
2205 DURHAM ST, TAMPA, FL 33605-6135
(813) 507-0580

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
900341538
FL
Enumeration date
07/21/2020
Last updated
07/21/2020
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