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General NPI Number Information
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NPI Number | 1386801421
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Entity Type | Individual
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Provider Name | TAMEATRICE MICHELLE JACKSON RN/CRT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 2506 CHESTNUT SPRINGS LN
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City | JACKSONVILLE
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State | FL
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Zip | 32246-1323
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Country | US
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Telephone | 904-382-1793
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Fax | 904-253-6759
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Provider Business Mailing Address
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Address Line | 2506 CHESTNUT SPRINGS LN
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City | JACKSONVILLE
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State | FL
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Zip | 32246-1323
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Country | US
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Telephone | 904-382-1793
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Fax | 904-253-6759
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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 | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number | RN9255446
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License Number State | FL
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