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General NPI Number Information
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NPI Number | 1831385848
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Entity Type | Individual
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Provider Name | NICOLE S JACKSON FNP
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Gender | Female
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 4 SKIDAWAY VILLAGE WALK STE B
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City | SAVANNAH
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State | GA
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Zip | 31411-2962
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Country | US
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Telephone | 912-598-6312
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Fax | 912-335-7897
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Provider Business Mailing Address
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Address Line | 150 JOHNNY MERCER BLVD
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City | SAVANNAH
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State | GA
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Zip | 31410-2102
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Country | US
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Telephone | 912-897-3220
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN277697
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F334631 1
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License Number State | NY
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