Provider Demographics
NPI:1568892073
Name:JACKSON, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:UNIVERSITY OF CINCINNATI ACADEMIC HEALTH CTR
Mailing Address - Street 2:231 ALBERT SABIN WAY, SUITE 1358
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0769
Mailing Address - Country:US
Mailing Address - Phone:513-558-8090
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CINCINNATI ACADEMIC HEALTH CTR
Practice Address - Street 2:231 ALBERT SABIN WAY, SUITE 1358
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0769
Practice Address - Country:US
Practice Address - Phone:513-558-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14836-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily