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General NPI Number Information
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NPI Number | 1194494880
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Entity Type | Organization
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Legal Business Name | JACKSONS HEALTH FAMILY HEALTH NP
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/08/2024
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Provider Practice Location Address
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Address Line | 1655 ELMWOOD AVE STE 125
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City | ROCHESTER
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State | NY
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Zip | 14620-3428
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Country | US
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Telephone | 585-340-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 978 CLINTON AVE S
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City | ROCHESTER
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State | NY
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Zip | 14620-2040
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Country | US
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Telephone | 585-576-1001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARNEL JACKSON
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Credential | FNP
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Telephone | 585-340-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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