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General NPI Number Information
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NPI Number | 1306128533
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Entity Type | Individual
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Provider Name | SHUNTA JACKSON-SMITH APRN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 2923 S FEDERAL HWY STE 100
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7751
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Country | US
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Telephone | 561-752-0100
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Fax | 561-740-3001
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Provider Business Mailing Address
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Address Line | 2923 S FEDERAL HWY STE 100
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7751
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Country | US
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Telephone | 561-752-0100
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Fax | 561-740-3001
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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 | APRN9196308
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License Number State | FL
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