Diane Regina Jackson, ARNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

ARNP2121402 Issued in FL

Practice address

1248 E Hillsborough Ave
221
Tampa, FL 33604-7201

Phone

(813) 516-0679

NPI assigned

Nov 19, 2012

Last updated

Nov 20, 2014By the provider in NPPES

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

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• In Home Primary Care Provider, LLC

  • Nurse Practitioner
  • Zephyrhills, FL
  • NPI 1730481326
  NPD (past)

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1467796128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27038 SEA BREEZE WAY",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335446617",
            "telephone_number": "813-516-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1248 E HILLSBOROUGH AVE",
            "address_2": "221",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336047201",
            "telephone_number": "813-516-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DIANE",
        "middle_name": "REGINA",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "ARNP2121402",
            "primary": true
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "FL",
            "license": "ARNP2121402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clare Quirk Jackson, MSPT
• Constance L Jackson, MD
• Darwin C Jackson, MD
• Deanna Jackson, PHLEBOTOMIST, DOULA
• Dericka Jackson
• Geoffrey Alan Jackson, DDS
• Gerrard Jackson
• Jahyra Anae Jackson
• Jayleene Jackson
• Jenae Jackson

• Primary Care Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.