Provider Demographics
NPI:1356496160
Name:JACKSON, ARIANE ANNOUCK (AP)
Entity Type:Individual
Prefix:
First Name:ARIANE
Middle Name:ANNOUCK
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32668 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3113
Mailing Address - Country:US
Mailing Address - Phone:727-789-3110
Mailing Address - Fax:727-789-1489
Practice Address - Street 1:32668 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3113
Practice Address - Country:US
Practice Address - Phone:727-789-3110
Practice Address - Fax:727-789-1489
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist