Jackson, Jacqueline Kay

Jackson, Jacqueline Kay is an individual health care provider with primary practice located at 1621 Ne Waldo Rd , Gainesville FL 32609-3900. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as her primary health care specialty. Jackson, Jacqueline Kay can be contacted via phone (352) 264-8272.

Contact Information

Primary practice address
1621 Ne Waldo Rd Gainesville FL 32609-3900
Phone: (352) 264-8272
Fax: (352) 264-8304
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X ME 0058078 Florida

Profile Details

NPI number 1104157643
LBN Legal business name Jackson, Jacqueline Kay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 22nd, 2010
Last updated Feb 25th, 2019 - about 5 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 1104157643 NPPES
Florida MEDICAID 010829000

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