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NPI Code Detail

MEDICARE: RILEY ELIZABETH JACKSON

MEDICARE: RILEY ELIZABETH 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1588504740
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY ELIZABETH JACKSON
Provider Business Mailing Address
First Line : 6675 CORPORATE CENTER PKWY STE 115
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8088
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6675 CORPORATE CENTER PKWY STE 115
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8088
Country : US
Telephone Number : 904-245-8910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ RILEY ELIZABETH JACKSON ” Practice Location

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