Provider Demographics
NPI:1790462976
Name:JACKSON, MARINDA ANN (HOME HEALTH PROVIDER)
Entity Type:Individual
Prefix:
First Name:MARINDA
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:HOME HEALTH PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9390 FM 1960 BYPASS RD W APT 606
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4076
Mailing Address - Country:US
Mailing Address - Phone:346-386-5183
Mailing Address - Fax:
Practice Address - Street 1:9390 FM 1960 BYPASS RD W APT 606
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4076
Practice Address - Country:US
Practice Address - Phone:346-386-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide