Individual
CLAUDETTE F JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
13782 PLANTATION RD STE 201, FORT MYERS, FL 33912-4462
(239) 343-1100
(239) 343-1101
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-1100
(239) 343-1101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA902
KY
363A00000X
Physician Assistant
Primary
PA9109552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595343
BCBS
KY
05
—
113774800
—
FL
01
—
P00706704
RAILROAD MEDICARE
KY
Enumeration date
08/19/2005
Last updated
04/18/2022
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