Doctor Name: | HEIDI A JACKSON |
NPI Number: | 1508942954 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | F332937 |
Business Practice Address: | 21 Edward J Lempka Dr Florida, NY - 109211036 |
Business Phone Number: | 8456511777 |
Business Fax Number: | 8456513299 |
Mailing Address: | 158 N Main St, Po Box 299 FLORIDA |
State: | NY |
Postal Code: | 109211133 |
Phone Number: | 8456511400 |
Fax Number: | 8456511510 |
NPI Enumeration Date: | 10/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F332937 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |