MEDICARE: MS. JOYCE JACQUETTA JACKSON NP

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
1	363L00000X	Nurse Practitioner	R109047	MD
2	363L00000X	Nurse Practitioner	0024167148	VA
3	363L00000X	Nurse Practitioner	622905	CA

General Provider Information

NPI Number	:	1932377702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOYCE JACQUETTA JACKSON NP

Provider Business Mailing Address
First Line	:	3450 OLD WASHINGTON ROAD
Second Line	:	SUITE 202
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-3590
Fax Number	:	301-705-1941

Provider Business Practice Location Address
First Line	:	3450 OLD WASHINGTON ROAD
Second Line	:	SUITE 202
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-3590
Fax Number	:	301-705-1941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

Similar Medicare Providers

1205818325 — DR. LANE T KNIGHT DDS
Practice Location Address:

3450 OLD WASHINGTON RD , STE 201
WALDORF, MD
20602-3248

Practice Phone: 301-645-6911
Practice Fax: 301-843-0083

1659353423 — DR. JOHN J HEFFRON DDS
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 201
WALDORF, MD
20602-3248

Practice Phone: 301-645-6911
Practice Fax: 301-843-0083

1811970056 — RICHARD EUGENE COOK JR. M.D.
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 103
WALDORF, MD
20602-3248

Practice Phone: 301-472-4290
Practice Fax: 240-607-3609

1174559298 — SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 201
WALDORF, MD
20602-3248

Practice Phone: 301-645-6911
Practice Fax: 301-843-0083

1427123983 — MR. DAVID EDWARD KANE D.C.
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 101
WALDORF, MD
20602-3248

Practice Phone: 301-638-7300
Practice Fax: 301-638-7306

1417143041 — ADVANCED SURGICARE OF MARYLAND P.A
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 202
WALDORF, MD
20602-3248

Practice Phone: 301-645-3590
Practice Fax: 301-705-1941

Directions to “ MS. JOYCE JACQUETTA JACKSON NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.