Provider Demographics
NPI:1265255442
Name:JACKSON, LINDSEY MAUREEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MAUREEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 QUITTIE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-2104
Mailing Address - Country:US
Mailing Address - Phone:484-769-8096
Mailing Address - Fax:
Practice Address - Street 1:1110 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1501
Practice Address - Country:US
Practice Address - Phone:610-988-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2024088267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily