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NPI Code Detail

MEDICARE: MANAMI JACKSON

MEDICARE: MANAMI 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
11041C0700XClinical Social WorkerSW15860FL
21041C0700XClinical Social WorkerFL

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 : 1467617613
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANAMI JACKSON
Provider Business Mailing Address
First Line : 126 LITHIA PINCREST ROAD
Second Line :
City : BRANDON
State : FL
Zip : 33511
Country : US
Telephone Number : 813-689-8828
Fax Number : 836-689-8802
Provider Business Practice Location Address
First Line : 126 LITHIA PINECREST RD
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number : 813-689-8828
Fax Number : 813-689-8802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2008
Last Update Date : 09/20/2024

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Directions to “ MANAMI JACKSON ” Practice Location

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