MEDICARE: T JACKSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5020358	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5020358	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033681655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	T JACKSON APRN

Provider Business Mailing Address
First Line	:	713 MILTON BLUFF LANE
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4503
Country	:	US
Telephone Number	:	984-332-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 MILTON BLUFF LANE
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4503
Country	:	US
Telephone Number	:	984-332-7015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/23/2025

Similar Medicare Providers

1881698462 — DR. MARYBETH GUEVARA DC
Practice Location Address:

3152 BLUE MOUNTAIN WAY
COLORADO SPRINGS, CO
80906-4503

Practice Phone: 719-684-7832
Practice Fax:

1548343148 — DR. WILLIAM W. WOODS III DMD
Practice Location Address:

4503 POPLAR SPRINGS DR
MERIDIAN, MS
39305-2617

Practice Phone: 601-693-3200
Practice Fax: 601-482-1158

1013164094 — MRS. DEBORAH J WILSON SLP
Practice Location Address:

5240 FERRARI DR
COLORADO SPRINGS, CO
80922-4503

Practice Phone: 719-357-1346
Practice Fax:

1922390475 — DR. JASON MICHAEL BIENIA DDS
Practice Location Address:

410 20TH ST
GLENWOOD SPRINGS, CO
81601-4503

Practice Phone: 970-309-6127
Practice Fax:

1427462274 — DANIEL LEW DO
Practice Location Address:

1550 PULSAR DR
COLORADO SPRINGS, CO
80916-4503

Practice Phone: 719-632-4455
Practice Fax:

1801250022 — CAROLYN G. DUDLEY, MD, PC
Practice Location Address:

956 PERSIMMON PT
SANDY SPRINGS, GA
30328-4503

Practice Phone: 770-331-3227
Practice Fax: 404-843-9398

Directions to “ T JACKSON APRN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.