Healthcare Provider Details

I. General information

NPI: 1063346732
Provider Name (Legal Business Name): AMBER JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W HIGHLAND BLVD
INVERNESS FL
34452-4720
US

IV. Provider business mailing address

2942 SE 5TH TER
OCALA FL
34471-6665
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-1551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11048237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: