Provider Demographics
NPI:1033413091
Name:TANIA WHITE-JACKSON, PA
Entity Type:Organization
Organization Name:TANIA WHITE-JACKSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-981-3535
Mailing Address - Street 1:6300 W PARKER RD BLDG 2
Mailing Address - Street 2:STE 325
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-3535
Mailing Address - Fax:972-981-3536
Practice Address - Street 1:6300 W PARKER RD BLDG 2
Practice Address - Street 2:STE 325
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-3535
Practice Address - Fax:972-981-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9439207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty