Provider Demographics
NPI:1144751876
Name:JACKSON, CINDY L (LPN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:FLORENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1351 BERNARD SMITH RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-8419
Mailing Address - Country:US
Mailing Address - Phone:912-682-7892
Mailing Address - Fax:
Practice Address - Street 1:992 MANER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-4334
Practice Address - Country:US
Practice Address - Phone:912-682-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR30953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse