Provider Demographics
NPI:1477213239
Name:JACKSON, SYLINA
Entity Type:Individual
Prefix:
First Name:SYLINA
Middle Name:
Last Name:JACKSON
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 1:8527 JENNIFER DR APT 3
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9094
Mailing Address - Country:US
Mailing Address - Phone:907-209-1202
Mailing Address - Fax:
Practice Address - Street 1:10801 BLACK BEAR RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8783
Practice Address - Country:US
Practice Address - Phone:907-789-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker