Jackson, Edwin

Jackson, Edwin is an individual health care provider with primary practice located at 4010 Central Ave , St Petersburg FL 33711-1239. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Jackson, Edwin can be contacted via phone (727) 327-7656.

Contact Information

Primary practice address
4010 Central Ave St Petersburg FL 33711-1239
Phone: (727) 327-7656
Fax: (727) 388-1192
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X ME 87406 Florida
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X ME 87406 Florida

Profile Details

NPI number 1740294883
LBN Legal business name Jackson, Edwin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Oct 10th, 2011 - about 13 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 1740294883 NPPES
Florida Other F01714 FLORIDA HEALTH PARTNERS

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