Individual
TIMOTHY L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5249 PROVIDENCE RD, VIRGINIA BEACH, VA 23464-4201
(757) 467-3900
(757) 467-7800
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-00505
NC
363A00000X
Physician Assistant
Primary
0110002037
VA
Other
Enumeration date
07/19/2006
Last updated
10/14/2025
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