Healthcare Provider Details

I. General information

NPI: 1093628273
Provider Name (Legal Business Name): TONONIA JONELLE JACKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 TORRINGTON DR
TOLEDO OH
43615-5437
US

IV. Provider business mailing address

3627 HOMEWOOD AVE # A
TOLEDO OH
43612-1007
US

V. Phone/Fax

Practice location:
  • Phone: 419-351-7021
  • Fax:
Mailing address:
  • Phone: 419-351-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.330476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: