Provider Demographics
NPI:1417480963
Name:JACKSON TURPIN, TAQWANNA
Entity Type:Individual
Prefix:MRS
First Name:TAQWANNA
Middle Name:
Last Name:JACKSON TURPIN
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 1:2401 2ND ST NW APT 7
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4935
Mailing Address - Country:US
Mailing Address - Phone:863-292-5976
Mailing Address - Fax:
Practice Address - Street 1:659 REINDEER DR
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-4318
Practice Address - Country:US
Practice Address - Phone:863-242-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide