Provider Demographics
NPI:1013565811
Name:JACKSON, SAMIA (APRN)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:6520 FORT CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2044
Mailing Address - Country:US
Mailing Address - Phone:904-744-7300
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:14444 BEACH BLVD STE 28
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2080
Practice Address - Country:US
Practice Address - Phone:904-367-2277
Practice Address - Fax:904-421-3788
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002840363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily