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Contact Information

ELISA KRILL JACKSON, MD
1475 NW 12TH AVE FL 32
MIAMI, FL33136-1002
 Phone: 305-243-5302
 Fax: 305-243-9161
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hematology & Oncology

207RH0003X 11 Physician/Internal Medicine
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for ELISA KRILL JACKSON · (Female)

NPI # 1427046085
Status Active
Credentials MD
Entity Individual
Enumeration date 10/07/2005
Last updated 10/31/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • FL License # 0066352
  • FL License # ME66352
  • FL Medicaid 272074400
Hospital affiliation(s)
  • MEMORIAL REGIONAL HOSPITAL - (Acute Care)
    3501 JOHNSON ST
    HOLLYWOOD, FL 33021
  • MOUNT SINAI MEDICAL CENTER - (Acute Care)
    4300 ALTON RD
    MIAMI BEACH, FL 33140
  • UNIVERSITY OF MIAMI HOSPITAL AND CLINICS - (Acute Care)
    1475 NW 12TH AVE
    MIAMI, FL 33136
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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