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General NPI Number Information
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NPI Number | 1801232954
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Entity Type | Individual
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Provider Name | DANELLE LYN JACKSON APN
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Gender | Female
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 2090 SMOKETREE AVE N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5806
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Country | US
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Telephone | 928-854-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 839 W CONGRESS ST
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City | TUCSON
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State | AZ
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Zip | 85745-2819
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Country | US
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Telephone | 520-670-3909
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Fax | 520-309-2500
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209010509
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License Number State | IL
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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 | 99057031A
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License Number State | IN
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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 | 288807
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License Number State | AZ
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