Individual
TRACIE LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LMNT, CDCES
Contact information
Practice address
1440 SW 3RD AVE, OCALA, FL 34471-6513
(352) 402-5295
Mailing address
PO BOX 127, HERMAN, NE 68029-0127
(402) 456-7876
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
12865
FL
133V00000X
Registered Dietitian
347
NE
Other
Enumeration date
06/08/2007
Last updated
04/29/2024
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