Jackson, Grace Nightingale Cortez
Jackson, Grace Nightingale Cortez is an individual health care provider with primary practice located at 3445 Executive Center Drive Suite 250, Austin TX 78731-1678. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anatomic Pathology, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is her primary health care specialty. Jackson, Grace Nightingale Cortez can be contacted via phone (512) 579-4000.Contact Information
Primary practice address
3445 Executive Center Drive Suite 250
Austin TX 78731-1678
Phone: (512) 579-4000
Fax: (512) 439-2814
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology | 207ZP0101X | BP1-0016584 | Texas |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | N1690 | Texas |
Profile Details
| NPI number | 1104020775 |
|---|---|
| LBN Legal business name | Jackson, Grace Nightingale Cortez |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2007 |
| Last updated | Oct 15th, 2014 - about 10 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 | 1104020775 | NPPES |
| Texas | MEDICAID | 204459601 |
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