| Organization Name: | J&E JACKSON ENTERPRISES, PLLC |
| NPI Number: | 1346625522 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMILY JACKSON (PHYSICIAN) |
| Mailing Address: | 1677 Eagle Harbor Pkwy # C Fleming Island |
| State: | FL US |
| Postal Code: | 320034802 |
| Phone Number: | 9042785112 |
| Fax Number: | |
| NPI Enumeration Date: | 07/29/2015 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | PO3484 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |