Eileen Jackson, ACNP-BC, CRNFA

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN-075070 Issued in AZ

Practice address

11957 E Summer TRL
Tucson, AZ 85749-9313

Phone

(520) 444-8940

Fax

(520) 760-6690

NPI assigned

Oct 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Hospital Hospital, Tucson, AZ, CCN 030011
• Tucson Medical Center Hospital, Tucson, AZ, CCN 030006

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Independent First Assist Inc.

  • Acute Care Nurse Practitioner
  • Tucson, AZ
  • NPI 1851615710
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• SMSJ Tucson Holdings LLC

  • General Acute Care Hospital
  • Tucson, AZ
  • NPI 1538535158
  Care Compare affiliation
• Tucson Medical Center

  • General Acute Care Hospital
  • Tucson, AZ
  • NPI 1174512792
  Care Compare affiliation

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

{
    "created_epoch": "1162080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1295811511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32500",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857512500",
            "telephone_number": "520-444-8940",
            "fax_number": "520-760-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11957 E SUMMER TRL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857499313",
            "telephone_number": "520-444-8940",
            "fax_number": "520-760-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EILEEN",
        "credential": "ACNP-BC, CRNFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-29",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "AZ",
            "license": "RN-075070",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "RN-075070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "918849",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• C'NE Angelique Jackson
• Cecilia T. Jackson, CNM
• Danelle Lyn Jackson, APN
• Daniel Ray Jackson, MD, MPH
• Derek Jackson
• James Jackson I
• Jessie R Jackson
• Kewuan Deshaun Jackson
• Kia Nyketta Jackson
• Ladonna Jackson

• Acute Care Nurse Practitioner in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Acute Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.