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General NPI Number Information
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NPI Number | 1619413861
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE JACKSON NP
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2100 OCOEE APOPKA RD
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City | APOPKA
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State | FL
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Zip | 32703-9210
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Country | US
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Telephone | 407-889-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1735 OVERDALE DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-2586
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Country | US
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Telephone | 423-715-9858
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22453
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License Number State | TN
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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 | 22453
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License Number State | TN
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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 | APRN11024679
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 230181
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License Number State | LA
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