Individual
JACQUELINE MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24267 SW 117TH AVE, HOMESTEAD, FL 33032-4404
(305) 951-8358
Mailing address
24267 SW 117TH AVE, HOMESTEAD, FL 33032-4404
(305) 951-8358
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
9303641
FL
163WG0000X
General Practice Registered Nurse
9300641
FL
163WG0600X
Gerontology Registered Nurse
9303641
FL
163WI0600X
Infection Control Registered Nurse
9303641
FL
163WW0000X
Wound Care Registered Nurse
9303641
FL
Other
Enumeration date
08/08/2021
Last updated
08/08/2021
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