Provider Demographics
NPI:1639477789
Name:JACKSON HEALTH SYSTEM
Entity Type:Organization
Organization Name:JACKSON HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC, NP-C
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-632-9578
Mailing Address - Street 1:2034 NW 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2864
Mailing Address - Country:US
Mailing Address - Phone:305-585-1140
Mailing Address - Fax:305-585-0031
Practice Address - Street 1:16455 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-3675
Practice Address - Country:US
Practice Address - Phone:786-955-6089
Practice Address - Fax:786-955-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1896652261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center