Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME116991 | FL |
N | 207PE0004X | Emergency Medical Services | 0101242302 | VA |
NPI | 1053502187 |
---|---|
Provider Name | Dr. Corinne Sokolik Jackson |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 26/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003136836A | (05) | GA |
009390600 | (05) | FL |
14RF3 | BCBS (01) | FL |
HO142Z | (02) | FL |