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General NPI Number Information
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NPI Number | 1528160181
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Entity Type | Individual
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Provider Name | TERESA A JACKSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 20612 NW 27TH AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1469
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Country | US
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Telephone | 305-637-6400
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Fax | 305-636-5155
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Provider Business Mailing Address
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Address Line | 5607 NW 27TH AVE STE 1
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City | MIAMI
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State | FL
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Zip | 33142-2826
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Country | US
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Telephone | 305-805-1700
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Fax | 305-805-1715
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2904542
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2904542
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License Number State | FL
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