Jackson Taravine Sr

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

JACKSON TARAVINE SR

Practice address

1256 W Chandler Blvd Ste G
Chandler, AZ 85224-5208

Phone

(480) 712-7108

Fax

(480) 300-5840

NPI assigned

Dec 9, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Jackson Taravine Sr., PANPI 1811770910

Title

Owner

Phone

(786) 865-3586

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jackson Taravine

  • Medical Physician Assistant
  • Surprise, AZ
  • NPI 1811770910
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1765238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772496000000",
    "number": "1467316042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15182 N 75TH AVE STE 180",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814722",
            "telephone_number": "480-300-5798",
            "fax_number": "480-300-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1256 W CHANDLER BLVD STE G",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245208",
            "telephone_number": "480-712-7108",
            "fax_number": "480-300-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON TARAVINE SR",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-09",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A",
        "authorized_official_last_name": "TARAVINE",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-865-3586",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sallu M. Jabati, M.D.
• Khaldoun Jabi, MD
• Rebecca Jacewicz
• Jack Wright Dentistry PC
• Brianna Lynn Jack, M.A,BCBA,LBA
• Corliss Colleen Jackson, REIKI MASTER
• Darius Jackson, PT, DPT
• Desiree Nicole Jackson
• Heidi A Jackson, ARNP
• Maryn Jackson

• Medical Physician Assistant in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.