NPIMap

Individual provider Active NPI

Nicole Jackson

  • Pharmacist
  • Fort Walton Beach, FL
National Provider Identifier
1609231810
Registry record updated Dec 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS32321 Issued in FL
Practice address
421 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4084
Phone
(850) 301-1334
Fax
(850) 301-1339
NPI assigned
Dec 15, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS32321 FL Primary

Addresses

Primary practice location

421 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4084

Mailing address

421 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4084
Phone (850) 301-1334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PS32321FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Publix Super Markets Inc Past Accepting new patients
Publix Super Markets Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1450137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450137600000",
    "number": "1609231810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 MARY ESTHER CUT OFF NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325484084",
            "telephone_number": "850-301-1334",
            "fax_number": "850-301-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 MARY ESTHER CUT OFF NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325484084",
            "telephone_number": "850-301-1334",
            "fax_number": "850-301-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-15",
        "last_updated": "2015-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS32321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.