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General NPI Number Information
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NPI Number | 1467146878
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Entity Type | Individual
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Provider Name | GARTH JACKSON AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 79 SPINYTHORN RD
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City | LEVITTOWN
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State | PA
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Zip | 19056-2216
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Country | US
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Telephone | 215-783-8014
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Fax |
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Provider Business Mailing Address
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Address Line | 79 SPINYTHORN RD
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City | LEVITTOWN
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State | PA
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Zip | 19056-2216
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Country | US
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Telephone |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26NJ01474100
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License Number State | NJ
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