National Provider Identifier Database

JACQUELINE M JACKSON
Administrator


Contact Information

JACQUELINE M JACKSON
24267 SW 117TH AVE
HOMESTEAD, FL33032-4404
Phone: 305-951-8358
Fax:
Website:
Specialty Taxonomy Code
* Administrator 163WA2000X
General Practice 163WG0000X
Gerontology 163WG0600X
Infection Control 163WI0600X
Wound Care 163WW0000X

* Indicates primary specialty

NPI Profile & details for JACQUELINE M JACKSON

NPI Number 1972277317
Credentials
Entity Individual
Enumeration date 08/08/2021
Last updated 08/08/2021 - About 5 years ago
Sole proprietor1 Yes
Identifiers
  • FL License #: 9300641
  • FL License #: 9303641
Hospital affiliation n/a

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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