Provider Demographics
NPI:1558761122
Name:JACKSON-DRAGO, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:JACKSON-DRAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ONA
Other - Last Name:DRAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:5650 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4904
Mailing Address - Country:US
Mailing Address - Phone:954-253-8294
Mailing Address - Fax:
Practice Address - Street 1:5650 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4904
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9300444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily