Healthcare Provider Details

I. General information

NPI: 1063284271
Provider Name (Legal Business Name): ISABEL PAOLA JACKMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 700 N SUITE 102
LINDON UT
84042
US

IV. Provider business mailing address

1971 700 N SUITE 102
LINDON UT
84042
US

V. Phone/Fax

Practice location:
  • Phone: 801-697-6006
  • Fax:
Mailing address:
  • Phone: 801-697-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10524740-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: