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NPI Code Detail

MEDICARE: MRS. TANEISHA JACSON FNP-BC

MEDICARE: MRS. TANEISHA JACSON FNP-BC
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
1363LF0000XFamily Nurse PractitionerRN1003671DC

General Provider Information

NPI Number : 1740505783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TANEISHA JACSON FNP-BC
Provider Business Mailing Address
First Line : 5023 36TH PL
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-3909
Country : US
Telephone Number : 240-441-8441
Fax Number :
Provider Business Practice Location Address
First Line : 4660 MARTIN LUTHER KING JR AVE SW STE A3
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4958
Country : US
Telephone Number : 202-558-4681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2010
Last Update Date : 04/01/2010

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