Jackson, Richard E

Jackson, Richard E is an sole proprietor health care provider with primary practice located at 21260 Olean Blvd Ste 200 , Port Charlotte FL 33952-6742. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Jackson, Richard E can be contacted via phone (941) 625-4270.

Contact Information

Primary practice address
21260 Olean Blvd Ste 200 Port Charlotte FL 33952-6742
Phone: (941) 625-4270
Fax: (941) 625-1751
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA2962 Florida

Profile Details

NPI number 1174587505
LBN Legal business name Jackson, Richard E
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 13th, 2006
Last updated Sep 9th, 2020 - about 4 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 1174587505 NPPES
Florida MEDICAID 290761500

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