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General NPI Number Information
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NPI Number | 1225877350
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Entity Type | Individual
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Provider Name | TOCARA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1211 TECH BLVD
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City | TAMPA
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State | FL
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Zip | 33619-7846
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Country | US
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Telephone | 407-272-5953
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 MYSTIC SEAFLOOR DR APT 134
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City | RIVERVIEW
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State | FL
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Zip | 33578-4969
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Country | US
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Telephone | 407-272-5953
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 19424
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License Number State | FL
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