Henderson-Jackson, Evita B

Henderson-Jackson, Evita B is an individual health care provider with primary practice located at 12902 Usf Magnolia Dr , Tampa FL 33612-9416. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is her primary health care specialty. Henderson-Jackson, Evita B can be contacted via phone (813) 745-7487.

Contact Information

Primary practice address
12902 Usf Magnolia Dr Tampa FL 33612-9416
Phone: (813) 745-7487
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X TRN9826 Florida
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X ME104658 Florida

Profile Details

NPI number 1578752598
LBN Legal business name Henderson-Jackson, Evita B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2007
Last updated May 15th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578752598 NPPES
Florida Other 14K4D BLUE CROSS BLUE SHIELD

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