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General NPI Number Information
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NPI Number | 1013881978
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Entity Type | Individual
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Provider Name | LAKESHA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 14782 SW 171ST AVE
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City | INDIANTOWN
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State | FL
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Zip | 34956-3938
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Country | US
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Telephone | 772-475-6208
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Fax |
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Provider Business Mailing Address
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Address Line | 14752 SW 175TH CT
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City | INDIANTOWN
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State | FL
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Zip | 34956-3925
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Country | US
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Telephone | 772-475-6208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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