Jackson Medical Enterprise

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME 104632 Issued in FL

Legal business name

JACKSON MEDICAL ENTERPRISE

Practice address

4800 Aston Gardens Way
Medical Director's Office
Naples, FL 34109-3501

Phone

(239) 330-1301

NPI assigned

May 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Malia M Jackson Rodriguez, M.D.

Title

Owner

Phone

(239) 207-0948

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Joy Fedak, P.A.

  • Physician Assistant
  • Bradenton, FL
  • NPI 1851619910
  NPD (past)
• Heather Leigh Paris, PA-C

  • Physician Assistant
  • Naples, FL
  • NPI 1396997433
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1023463429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2263 CAMPESTRE TER",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341193358",
            "telephone_number": "239-207-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 ASTON GARDENS WAY",
            "address_2": "MEDICAL DIRECTOR'S OFFICE",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341093501",
            "telephone_number": "239-330-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL ENTERPRISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON RODRIGUEZ",
        "authorized_official_first_name": "MALIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-207-0948",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME 104632",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "ME 104632",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "ME 104632",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yeiny Izquierdo, HAS
• J Daniel Labs MD PA
• J.a.G Redefined Healthcare (Soleil Health and Wellness)
• Jac Naples L.L.C. (Gulf Shore Apothecary)
• Jackson Center, PA
• Angela Noelle Jackson, M.A.
• Howard Leslie Jackson, PT
• Jon Ryan Jackson, M.D.
• Kelly Ann Jackson, SLP
• Margaret Jackson

• Primary Care Clinic/Center in Naples, FL
• Providers in Naples, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.