Provider Demographics
NPI:1275756934
Name:JACKSON, TINISHA DANIELLE
Entity Type:Individual
Prefix:
First Name:TINISHA
Middle Name:DANIELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:WILIMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-998-0469
Mailing Address - Fax:302-998-0298
Practice Address - Street 1:GENERAL HEALTHCARE RESOURCES INC
Practice Address - Street 2:5700 KIRKWOOD HIGHWAY SUITE 203
Practice Address - City:WILIMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-998-0469
Practice Address - Fax:302-998-0298
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DENA000000129079376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide