Provider Demographics
NPI:1124386636
Name:JACKSON, PAIGE ROTON (NP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ROTON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N E ST STE 331
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6335
Mailing Address - Country:US
Mailing Address - Phone:850-484-6500
Mailing Address - Fax:850-444-1755
Practice Address - Street 1:1717 N E ST STE 331
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6335
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-444-1755
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9442755363L00000X
AL1-049797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily