MEDICARE: MS. TAMEATRICE MICHELLE JACKSON RN/CRT

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	374T00000X	Religious Nonmedical Nursing Personnel	RN9255446	FL

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	:	1386801421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMEATRICE MICHELLE JACKSON RN/CRT

Provider Business Mailing Address
First Line	:	2506 CHESTNUT SPRINGS LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1323
Country	:	US
Telephone Number	:	904-382-1793
Fax Number	:	904-253-6759

Provider Business Practice Location Address
First Line	:	2506 CHESTNUT SPRINGS LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1323
Country	:	US
Telephone Number	:	904-382-1793
Fax Number	:	904-253-6759

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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