Healthcare Provider Details

I. General information

NPI: 1851498703
Provider Name (Legal Business Name): NANCI ELIZABETH JACKSON RN,MSN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

6350 W A J HWY DEPARTMENT 100
TALBOTT TN
37877
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6100
  • Fax: 865-342-0100
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000005941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: