Jackson, Audrey Lee Farson

Jackson, Audrey Lee Farson is an sole proprietor health care provider with primary practice located at 1223 Gateway Dr Ste 1D , Melbourne FL 32901-2607. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Jackson, Audrey Lee Farson can be contacted via phone (321) 729-6166.

Contact Information

Primary practice address
1223 Gateway Dr Ste 1D Melbourne FL 32901-2607
Phone: (321) 729-6166
Fax: (321) 722-1237
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X APRN11026952 Florida
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X APRN11026952 Florida

Profile Details

NPI number 1114507332
LBN Legal business name Jackson, Audrey Lee Farson
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 12th, 2021
Last updated Feb 9th, 2024 - about 7 months 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 1114507332 NPPES
Florida Other SA065 MEDICARE HF
Florida MEDICAID 120782400 MEDICARE HF

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