Healthcare Provider Details

I. General information

NPI: 1952272742
Provider Name (Legal Business Name): TIFFANY CHELAN JACKSON MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 VAN BUREN ST APT 802
HOLLYWOOD FL
33020-5197
US

IV. Provider business mailing address

2165 VAN BUREN ST APT 802
HOLLYWOOD FL
33020-5197
US

V. Phone/Fax

Practice location:
  • Phone: 407-967-0225
  • Fax:
Mailing address:
  • Phone: 407-967-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9390732
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number558447
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: