Active NPI
Carolyn Jackson12
- Attendant Care Provider
- Lakeland, FL
National Provider Identifier
1255077574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- Practice address
- 6835 Huntington Hills Blvd
Lakeland, FL 33810-5379 - Phone
- (863) 602-4686
- NPI assigned
- May 10, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Primary |
Addresses
Primary practice location
6835 Huntington Hills Blvd
Lakeland, FL 33810-5379
Mailing address
6835 Huntington Hills Blvd
Lakeland, FL 33810-5379
Phone (863) 602-4686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652140800000",
"number": "1255077574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6835 HUNTINGTON HILLS BLVD",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338105379",
"telephone_number": "863-602-4686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6835 HUNTINGTON HILLS BLVD",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338105379",
"telephone_number": "863-602-4686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON12",
"first_name": "CAROLYN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-10",
"last_updated": "2022-05-10",
"certification_date": "2022-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.