Provider Demographics
NPI:1518435437
Name:JACKSON, VICTORIA LYNN (DNP, FNP-C, PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DNP, FNP-C, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD STE 1400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5263
Mailing Address - Country:US
Mailing Address - Phone:916-731-1831
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD STE 1400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5263
Practice Address - Country:US
Practice Address - Phone:916-731-1831
Practice Address - Fax:916-451-1020
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025977163W00000X
CA544793163WC1500X
CAPA56381363A00000X
CA95010493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant