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General NPI Number Information
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NPI Number | 1518435437
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Entity Type | Individual
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Provider Name | VICTORIA LYNN JACKSON DNP, FNP-C, PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 3160 FOLSOM BLVD STE 1400
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City | SACRAMENTO
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State | CA
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Zip | 95816-5263
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Country | US
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Telephone | 916-731-1831
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Fax | 916-451-1020
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Provider Business Mailing Address
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Address Line | 3160 FOLSOM BLVD STE 1400
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City | SACRAMENTO
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State | CA
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Zip | 95816-5263
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Country | US
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Telephone | 916-731-1831
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95025977
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 544793
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56381
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95010493
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License Number State | CA
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