Stefanie M Jackson, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP 2620432 Issued in FL

Practice address

1289 SW State Road 47
Lake City, FL 32025-0484

Phone

(386) 755-0421

Fax

(386) 487-1234

NPI assigned

Apr 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

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, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Internal Medicine PLLCGroup PAC ID 7618052580, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Lake City Hospital Hospital, Lake City, FL, CCN 100156

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Southern Internal Medicine PLLC

  • Internal Medicine Physician
  • Lake City, FL
  • NPI 1912188624
  Medicare reassignment Care Compare group NPD

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

• Notami Hospitals of Florida Inc

  • General Acute Care Hospital
  • Lake City, FL
  • NPI 1992751879
  Care Compare affiliation

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277424000000",
    "number": "1346204427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1289 SW STATE ROAD 47",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320250484",
            "telephone_number": "386-755-0421",
            "fax_number": "386-487-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 SW STATE ROAD 47",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320250484",
            "telephone_number": "386-755-0421",
            "fax_number": "386-487-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEFANIE",
        "middle_name": "M",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-14",
        "last_updated": "2010-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP 2620432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ARNP2620432",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "275262",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "363L00000X",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "DE000Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorothy Jackson
• Johnna L Jackson, ARNP
• Lareesa Jackson
• Mardell Jackson
• Raven Jackson
• Ta'Sheika Jackson
• Terries Jackson
• Susan Lorraine Jacobsen
• Rashad D James
• Stanley Janasiewicz

• Nurse Practitioner in Lake City, FL
• Providers in Lake City, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; 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.