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General NPI Number Information
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NPI Number | 1619305174
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Entity Type | Individual
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Provider Name | ROSEMARY JACKSON MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 4960 SW 72ND AVE SUITE 400
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City | MIAMI
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State | FL
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Zip | 33155-5544
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Country | US
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Telephone | 954-649-5029
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Fax | 919-768-9193
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Provider Business Mailing Address
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Address Line | 309 APPALOOSA TRL
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City | BAHAMA
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State | NC
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Zip | 27503-9621
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Country | US
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Telephone | 954-649-5029
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Fax | 919-768-9193
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35379
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 263617
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101047114
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME92761
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License Number State | FL
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