MEDICARE: TONI JACKSON FNP

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	363LP2300X	Primary Care Nurse Practitioner	AP132143	TX

General Provider Information

NPI Number	:	1538619655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI JACKSON FNP

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	832-381-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 HIGH THICKET CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7853
Country	:	US
Telephone Number	:	832-381-7673
Fax Number	:

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

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	03/29/2026

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