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NPI Code Detail

MEDICARE: DR. MARIKA LAUREN COLLYMORE JACKSON DPM

MEDICARE: DR. MARIKA LAUREN COLLYMORE JACKSON DPM
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
1213E00000XPodiatristPO4497FL
2390200000XStudent in an Organized Health Care Education/Training Program
3213ES0103XFoot & Ankle Surgery PodiatristPO4497FL

General Provider Information

NPI Number : 1821672817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIKA LAUREN COLLYMORE JACKSON DPM
Provider Business Mailing Address
First Line : 630 JACKSONVILLE DR
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3814
Country : US
Telephone Number : 904-323-0954
Fax Number :
Provider Business Practice Location Address
First Line : 630 JACKSONVILLE DR
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3814
Country : US
Telephone Number : 904-323-0954
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2021
Last Update Date : 08/23/2025

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Directions to “ DR. MARIKA LAUREN COLLYMORE JACKSON DPM” Practice Location

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