MEDICARE: HANNAH JACKOWSKI RD

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	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	133V00000X	FL

General Provider Information

NPI Number	:	1154723302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH JACKOWSKI RD

Provider Business Mailing Address
First Line	:	2126 HOWARD DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-6132
Country	:	US
Telephone Number	:	706-280-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 STELZER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3034
Country	:	US
Telephone Number	:	407-463-7058
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	08/13/2021

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