Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0116029514 | VA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0116029514 | VA |
NPI | 1669821401 |
---|---|
Provider Name | Araba Amonu Jackson |
First Address | Tampa, FL 33606-3438 |
Second Address | Tampa, FL 33606-3438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 28/02/2020 |