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General NPI Number Information
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NPI Number | 1366610271
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Entity Type | Organization
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Legal Business Name | NICOLE S JACKSON, FAMILY NP,PC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1010 KENDAL WAY
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-1055
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Country | US
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Telephone | 914-922-1027
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Fax | 914-922-1158
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Provider Business Mailing Address
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Address Line | 3 COVENTRY CT
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City | CROTON ON HUDSON
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State | NY
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Zip | 10520-1001
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Country | US
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Telephone | 914-739-2245
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Fax |
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Authorized Official
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Title or Position | FNP-OWNER OF PC
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Name | NICOLE S JACKSON
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Credential | FNP
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Telephone | 914-739-2245
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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 |
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License Number State | NY
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