MEDICARE: MISS STEPHANIE KAY 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	163W00000X	Registered Nurse	RN9260330	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN11011834	FL
3	363LF0000X	Family Nurse Practitioner	APRN11011834	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	:	1164019774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE KAY JACKSON

Provider Business Mailing Address
First Line	:	500 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3094
Country	:	US
Telephone Number	:	863-293-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 AVENUE B NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4546
Country	:	US
Telephone Number	:	863-293-1191
Fax Number	:	863-401-8058

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	08/05/2022

Similar Medicare Providers

1710915954 — GANESH KV NAIR M.D.
Practice Location Address:

199 AVENUE B NW
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-293-1191
Practice Fax:

1689992893 — DR. MARIVETTE MACHADO CORTES MD
Practice Location Address:

199 AVENUE B NW
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-293-1191
Practice Fax:

1215248364 — MARIA BELEN RIVERA-BONILLA MD
Practice Location Address:

199 AVENUE B NW
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-293-1191
Practice Fax:

1609378868 — MELISSA L WELCH APRN
Practice Location Address:

199 AVENUE B NW STE 310
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-284-5000
Practice Fax:

1720578016 — ROBERT ARRIES FOSTER MD
Practice Location Address:

199 AVENUE B NW STE 310
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-292-4124
Practice Fax: 863-229-7568

1811567118 — BAYCARE MEDICAL GROUP INC
Practice Location Address:

199 AVENUE B NW STE 310
WINTER HAVEN, FL
33881-4546

Practice Phone: 863-519-1799
Practice Fax: 813-519-1798

Directions to “ MISS STEPHANIE KAY JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.