Provider Demographics
NPI:1376373134
Name:JACKSON, APRIL MONIQUE (FNP)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:MONIQUE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3552 W BASELINE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3042
Mailing Address - Country:US
Mailing Address - Phone:602-635-6941
Mailing Address - Fax:602-635-6952
Practice Address - Street 1:18275 N 59TH AVE STE 138
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1253
Practice Address - Country:US
Practice Address - Phone:602-564-1154
Practice Address - Fax:602-564-1154
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ310080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily