Provider Demographics
NPI:1811320674
Name:JACKSON, NAKITIA LETRECIA (RN, ARNP, AANP, ANCC)
Entity type:Individual
Prefix:
First Name:NAKITIA
Middle Name:LETRECIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, ARNP, AANP, ANCC
Other - Prefix:
Other - First Name:NAKITIA
Other - Middle Name:LETRECIA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ARNP, AANP, ANCC
Mailing Address - Street 1:6350 SW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6350 SW 10TH CT
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2721
Practice Address - Country:US
Practice Address - Phone:954-464-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9182178163W00000X
FLARNP9182178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily