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General NPI Number Information
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NPI Number | 1053602102
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Entity Type | Individual
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Provider Name | LEE DOUGLAS JACKSON NP-C
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Gender | Male
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 16271 BASS RD
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City | FORT MYERS
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State | FL
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Zip | 33908-3616
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Country | US
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Telephone | 239-343-7100
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Fax | 239-468-7924
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-9100
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Fax | 239-343-9108
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11027444
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60602473
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2011003377
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60602473
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5375350071
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License Number State | KS
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