Healthcare Provider Details

I. General information

NPI: 1255747796
Provider Name (Legal Business Name): YALONDA NACHOLE JACKSON MSN,ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 S SEACREST BLVD STE 114
BOYNTON BEACH FL
33435-7531
US

IV. Provider business mailing address

2623 S SEACREST BLVD STE 114
BOYNTON BEACH FL
33435-7531
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-4600
  • Fax: 833-625-1606
Mailing address:
  • Phone: 561-955-4600
  • Fax: 833-625-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9258698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: