Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 320087 | NY |
NPI | 1154763126 |
---|---|
Provider Name | Arnice Jackson |
First Address | San Francisco, CA 94111-3723 |
Second Address | New York, NY 10017-6145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 23/02/2021 |