| Doctor Name: | MS. PATRICIA L JACKSON |
| NPI Number: | 1073525150 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | E58698 |
| Business Practice Address: | 1 Wahoo Ave Groton, CT - 063492324 |
| Business Phone Number: | 8606944123 |
| Business Fax Number: | |
| Mailing Address: | 1 Wahoo Ave, GROTON |
| State: | CT |
| Postal Code: | 063492324 |
| Phone Number: | 8606944123 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2006 |
| NPI Last Update Date: | 08/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | E58698 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |