Provider Demographics
NPI:1770218513
Name:JACKSON, ALEXANDRA JABORNIK
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JABORNIK
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 RACE TRACK RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2389
Mailing Address - Country:US
Mailing Address - Phone:904-222-6364
Mailing Address - Fax:904-342-0442
Practice Address - Street 1:4125 RACE TRACK RD UNIT 104
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2389
Practice Address - Country:US
Practice Address - Phone:904-222-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027845364SP0200X, 364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics