Provider Demographics
NPI:1700953270
Name:JACKSON JAMES, APRIL MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:APRIL
Middle Name:MICHELLE
Last Name:JACKSON JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 N HESPERIDES ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5414
Mailing Address - Country:US
Mailing Address - Phone:813-467-6111
Mailing Address - Fax:813-467-6111
Practice Address - Street 1:5510 N HESPERIDES ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5414
Practice Address - Country:US
Practice Address - Phone:813-467-6111
Practice Address - Fax:407-467-6111
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
NC2668103TA0400X, 103TC2200X, 103TF0000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000295Medicaid
NC015978OtherVALUE OPTIONS
NC2162567OtherCIGNA
NC010561573OtherTRICARE
NC016VAOtherGROUP BLUE CROSS BLUE SHI
NC045G4OtherINDIV. BLUE CROSS BLUE SH
NCAETNAOtherAETNA
NC6005450Medicaid
NC6005450Medicaid