Provider Demographics
NPI:1023378577
Name:JACKSON, AARON LOUIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:LOUIS
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8332 NW 30TH TER
Mailing Address - Street 2:J1000
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1915
Mailing Address - Country:US
Mailing Address - Phone:407-792-2729
Mailing Address - Fax:
Practice Address - Street 1:8332 NW 30TH TER
Practice Address - Street 2:J1000
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1915
Practice Address - Country:US
Practice Address - Phone:407-792-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA17009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant