Provider Demographics
NPI:1417562711
Name:TIMOTHY-JACKSON, TARSHIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TARSHIA
Middle Name:
Last Name:TIMOTHY-JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 STERLINGTON RD APT 76
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2547
Mailing Address - Country:US
Mailing Address - Phone:318-436-6002
Mailing Address - Fax:
Practice Address - Street 1:2703 STERLINGTON RD APT 76
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2547
Practice Address - Country:US
Practice Address - Phone:318-436-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily