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NPI Code Detail

MEDICARE: DR. YVONNE ELIZABETH JACKSON

MEDICARE:  DR. YVONNE ELIZABETH JACKSON
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
1183500000XPharmacistPS47044FL

General Provider Information

NPI Number : 1952906679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YVONNE ELIZABETH JACKSON
Provider Business Mailing Address
First Line : 11375 W ATLANTIC BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33071-6369
Country : US
Telephone Number : 954-661-5831
Fax Number :
Provider Business Practice Location Address
First Line : 11375 W ATLANTIC BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33071-6369
Country : US
Telephone Number : 954-661-5831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “ DR. YVONNE ELIZABETH JACKSON ” Practice Location

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