Provider Demographics
NPI:1093176620
Name:JACKSON, JOCELYN (ARNP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6005
Mailing Address - Country:US
Mailing Address - Phone:239-280-1010
Mailing Address - Fax:239-261-0080
Practice Address - Street 1:775 1ST AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6005
Practice Address - Country:US
Practice Address - Phone:239-280-1010
Practice Address - Fax:239-261-0080
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9200079363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily