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NPI Code Detail

MEDICARE: MS. ROSLYN C BANKS-JACKSON MD

MEDICARE: MS. ROSLYN C BANKS-JACKSON MD
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
1207V00000XObstetrics & Gynecology Physician051865GA
2207V00000XObstetrics & Gynecology PhysicianME180168FL
3207V00000XObstetrics & Gynecology Physician036121554IL

General Provider Information

NPI Number : 1134112618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROSLYN C BANKS-JACKSON MD
Provider Business Mailing Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-0410
Fax Number : 478-275-0012
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-0410
Fax Number : 407-303-0417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 05/18/2026

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