Healthcare Provider Details

I. General information

NPI: 1427688597
Provider Name (Legal Business Name): LASHENA JACKSON DNP ARNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 BAYMEADOWS RD STE 3
JACKSONVILLE FL
32256-1842
US

IV. Provider business mailing address

3765 VICTORIA LAKES DR E
JACKSONVILLE FL
32226-5881
US

V. Phone/Fax

Practice location:
  • Phone: 904-933-8533
  • Fax: 904-212-4306
Mailing address:
  • Phone: 904-649-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberAPRN11005521
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11005521
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAPRN11005521
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005521
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11005521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: