Tiffany Nicole Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH16981 Issued in FL

Practice address

21808 State Road 54
Lutz, FL 33549-6923

Phone

(813) 428-6100

NPI assigned

May 30, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  NPD
• Wellness Psychological Services PLLC

  • Counseling Psychologist
  • Tampa, FL
  • NPI 1154794881
  NPD

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1164950630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 46421",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336460104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21808 STATE ROAD 54",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335496923",
            "telephone_number": "813-428-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANY",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH16981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ja Home Care Solutions
• Gillian Jackman, CNA, BT
• Chase Vaughn Jackson-Harris
• Kayon Daycia Jackson, APRN
• Latoya Mosely Jackson, M.S
• Jaffray Podiatry Center PL LLC
• Sheldon Jaggernauth, RPH
• Christine M. Jaggi, PHD
• Nancy Jaime-Williams, M.D.
• Jaime'S Adult Day Centers, LLC

• Mental Health Counselor in Lutz, FL
• Providers in Lutz, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.