Provider Demographics
NPI:1376676841
Name:JACKSON, DEBRA E (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:E
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 1:2370 TERENCE CT
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1215
Mailing Address - Country:US
Mailing Address - Phone:727-726-8776
Mailing Address - Fax:
Practice Address - Street 1:8730 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3106
Practice Address - Country:US
Practice Address - Phone:727-576-4229
Practice Address - Fax:727-578-0081
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1900652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily