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General NPI Number Information
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NPI Number | 1558294421
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Entity Type | Individual
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Provider Name | INGRID JACKSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 4959 PALO VERDE ST STE 100-A2
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City | MONTCLAIR
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State | CA
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Zip | 91763-2331
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Country | US
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Telephone | 909-447-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 4959 PALO VERDE ST STE 100-A2
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City | MONTCLAIR
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State | CA
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Zip | 91763-2331
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Country | US
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Telephone | 909-447-0405
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 95039768
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 95039768
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95039768
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95039768
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 95039768
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95039768
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License Number State | CA
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