Provider Demographics
NPI:1467821801
Name:JACKOLA, IRIS W
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:W
Last Name:JACKOLA
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 1:127 FIDELITY ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2002
Mailing Address - Country:US
Mailing Address - Phone:919-933-8381
Mailing Address - Fax:919-933-6623
Practice Address - Street 1:127 FIDELITY ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2002
Practice Address - Country:US
Practice Address - Phone:919-933-8381
Practice Address - Fax:919-933-6623
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC236553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily