Healthcare Provider Details

I. General information

NPI: 1710818927
Provider Name (Legal Business Name): AKENIA JACKSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4588 CHARLEEN TER
ORLANDO FL
32808-5014
US

IV. Provider business mailing address

4588 CHARLEEN TER
ORLANDO FL
32808-5014
US

V. Phone/Fax

Practice location:
  • Phone: 407-451-1659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5251956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: