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NPI Code Detail

MEDICARE: SANDINA SAMANTHA JACKSON APRN

MEDICARE: SANDINA SAMANTHA JACKSON APRN
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
1363L00000XNurse Practitioner5023920NC
2363L00000XNurse PractitionerAPRN11010356FL
3363L00000XNurse PractitionerSP035423PA

Other Identifiers

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

General Provider Information

NPI Number : 1225623408
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDINA SAMANTHA JACKSON APRN
Provider Business Mailing Address
First Line : 1000 36TH ST
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-4862
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 880 SW 145TH AVE STE 202
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33027-6171
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2021
Last Update Date : 03/17/2026

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