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General NPI Number Information
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NPI Number | 1770218513
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Entity Type | Individual
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Provider Name | ALEXANDRA JABORNIK JACKSON
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Gender | Female
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 4125 RACE TRACK RD UNIT 104
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City | ST JOHNS
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State | FL
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Zip | 32259-2389
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Country | US
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Telephone | 904-222-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 4125 RACE TRACK RD UNIT 104
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City | ST JOHNS
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State | FL
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Zip | 32259-2389
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Country | US
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Telephone | 904-222-6364
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Fax | 904-342-0442
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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 | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | APRN11027845
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License Number State | FL
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