Provider Demographics
NPI:1265689681
Name:JACKSON, NATOSHA NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:NATOSHA
Middle Name:NICOLE
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 1:5233 RICKER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1439
Mailing Address - Country:US
Mailing Address - Phone:904-800-2332
Mailing Address - Fax:904-634-7892
Practice Address - Street 1:1215 DUNN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6330
Practice Address - Country:US
Practice Address - Phone:904-757-1998
Practice Address - Fax:904-696-7462
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9177921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily