Peggy Ann Jackson, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW484 Issued in FL

Practice address

12590 Whitehall Dr
Fort Myers, FL 33907-4680

Phone

(239) 939-9090

Fax

(239) 482-8581

NPI assigned

Oct 31, 2008

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• AIDS Resource Council of Southwest Florida Inc

  • Infectious Disease Physician
  • Fort Myers, FL
  • NPI 1699826321
  NPD (past)
• Ivan L Mazzorana Jr MD PA

  • Psychiatry Physician
  • Ft Myers, FL
  • NPI 1790877488
  NPD (past)

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

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225411200000",
    "number": "1295988442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 ASTARIAS CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193200",
            "telephone_number": "239-482-8581",
            "fax_number": "239-482-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12590 WHITEHALL DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074680",
            "telephone_number": "239-939-9090",
            "fax_number": "239-482-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PEGGY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-31",
        "last_updated": "2008-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Eric Jackson, M.D.
• Keith Jackson
• Kory Jackson, NP
• Lee Douglas Jackson, NP-C
• Monserrat Guerrero Jackson
• Renuka Jackson
• William T Jackson
• Kenneth Michael Jacob, MD
• Sha'Nariyah Jacob, RBT
• Allen T Jacobs, MD

• Clinical Social Worker in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; 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.