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General NPI Number Information
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NPI Number | 1518729680
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Entity Type | Individual
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Provider Name | MONICA V. JACKSON FS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 1186 TREE SWALLOW DR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-2826
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Country | US
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Telephone | 321-765-7779
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 MICHIGAN AVE APT A
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City | WINTER PARK
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State | FL
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Zip | 32789-5415
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Country | US
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Telephone | 334-739-7739
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | FS887678
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License Number State | FL
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