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General NPI Number Information
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NPI Number | 1487615191
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Entity Type | Individual
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Provider Name | NANCY JACKSON RN PNP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1115 GARREDD BLVD
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-854-9416
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Fax | 706-863-8523
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Provider Business Mailing Address
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Address Line | 1115 GARREDD BLVD
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-854-9416
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Fax | 706-863-8523
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R110128
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License Number State | GA
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