Jackson, Dorothy Mae
Jackson, Dorothy Mae is an sole proprietor health care provider with primary practice located at 310 Sw 99Th St , Gainesville FL 32607-1372. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Jackson, Dorothy Mae can be contacted via phone (352) 332-1155.Contact Information
Primary practice address
310 Sw 99Th St
Gainesville FL 32607-1372
Phone: (352) 332-1155
Fax: (352) 331-6391
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X | 26-0167133 | Florida |
Profile Details
| NPI number | 1487950846 |
|---|---|
| LBN Legal business name | Jackson, Dorothy Mae |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 2nd, 2011 |
| Last updated | Feb 2nd, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487950846 | NPPES |
| Florida | Other | 681414096 | MEDICAID WAIVER |
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