Healthcare Provider Details

I. General information

NPI: 1659342780
Provider Name (Legal Business Name): JACKI D NASH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 EDGEWOOD DR S
LAKELAND FL
33803-3627
US

IV. Provider business mailing address

PO BOX 95004
LAKELAND FL
33804-5004
US

V. Phone/Fax

Practice location:
  • Phone: 863-666-8346
  • Fax: 863-668-3480
Mailing address:
  • Phone: 863-680-7206
  • Fax: 863-680-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberMH13
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: