MEDICARE: TASHEKA B JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	235410	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083191696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHEKA B JACKSON

Provider Business Mailing Address
First Line	:	604 W 18TH ST APT 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2748
Country	:	US
Telephone Number	:	904-405-9724
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 W 18TH ST APT 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2748
Country	:	US
Telephone Number	:	904-405-9724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	07/26/2018

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Directions to “ TASHEKA B JACKSON ” Practice Location

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