Healthcare Provider Details

I. General information

NPI: 1427451103
Provider Name (Legal Business Name): AMY JACKSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 NW 43RD LANE RD
OCALA FL
34482-8686
US

IV. Provider business mailing address

5224 NW 43RD LANE RD
OCALA FL
34482-8686
US

V. Phone/Fax

Practice location:
  • Phone: 269-208-0002
  • Fax:
Mailing address:
  • Phone: 269-208-0002
  • Fax: 480-275-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: