Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN11002840 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN11002840 | FL |
NPI | 1013565811 |
---|---|
Provider Name | Samia Jackson |
First Address | Jacksonville, FL 32277-2044 |
Second Address | Jacksonville, FL 32250-2080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 11/09/2019 |