| Doctor Name: | MS. LADAYSHA LATREACE JACKSON |
| NPI Number: | 1962743351 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | R872968 |
| Business Practice Address: | 2090 S Highway 29 Cantonment, FL - 325338699 |
| Business Phone Number: | 2282496203 |
| Business Fax Number: | |
| Mailing Address: | 5000 Mobile Hwy Ste 5, PENSACOLA |
| State: | FL |
| Postal Code: | 325063226 |
| Phone Number: | 8502812174 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2013 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R872968 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |