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General NPI Number Information
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NPI Number | 1699036756
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Entity Type | Individual
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Provider Name | IVETTE SYRA JACKSON APRN-NP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 315 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4291
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Country | US
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Telephone | 253-403-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 24312 E MAIN DR
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City | SAMMAMISH
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State | WA
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Zip | 98074-3460
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Country | US
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Telephone | 323-449-0452
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 111345
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | AP61619732
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | ARNP 9350748
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | AP61619732
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 95007329
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License Number State | CA
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