Nickolas Nathaniel Jackson, FNP, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

346970 Issued in NY

Practice address

13471 Bedell St
Jamaica, NY 11434-4551

Phone

(347) 759-9040

NPI assigned

Jan 26, 2021

Sex

Male

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

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

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.

• Dynamic Family Health NP PLLC

  • Family Nurse Practitioner
  • East Patchogue, NY
  • NPI 1487470423
  NPD Authorized official
• Medical Care at Home PC

  • Internal Medicine Physician
  • New York, NY
  • NPI 1811138415
  Medicare reassignment
• Medicine Check PC

  • Facial Plastic Surgery Physician
  • Staten Island, NY
  • NPI 1942979224
  Medicare reassignment
• Frank Zic, DPT, PT, PLLC

  • Physical Therapist
  • Wantagh, NY
  • NPI 1366994329
  NPD (past)

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1225628993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13471 BEDELL ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114344551",
            "telephone_number": "347-759-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13471 BEDELL ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114344551",
            "telephone_number": "347-759-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICKOLAS",
        "middle_name": "NATHANIEL",
        "credential": "FNP, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chanbria Jackson, LMSW
• Cherry Jackson
• Jamilah Jackson
• Kerita Jackson, FNP
• Lisa Nicole Jackson, M.D.
• Anna Jacob, FNP
• Shawn Jacob, DO
• Michael Yakubov Jacobi, DO
• Karen Jacobs
• Markiel Jacobs

• Family Nurse Practitioner in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.