Provider Demographics
NPI:1083896948
Name:JACKSON, NAIMA K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NAIMA
Middle Name:K
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3435 GATESHEAD MANOR WAY
Mailing Address - Street 2:#301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6136
Mailing Address - Country:US
Mailing Address - Phone:301-890-4495
Mailing Address - Fax:
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:LAUREL REGIONAL HOSPITAL
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-497-7940
Practice Address - Fax:301-497-8743
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002405363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical