Tabisha Jackson

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

License

21161Y05 Issued in CT

Practice address

157 Church St FL 19
New Haven, CT 06510-2100

Phone

(203) 584-6033

NPI assigned

Oct 20, 2022

Last updated

Oct 20, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Breeze Mobile Phlebotomy & More LLC

  • Phlebotomy Technician
  • New Haven, CT
  • NPI 1033834130
  NPD Authorized official

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1619694684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 CHURCH ST FL 19",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065102100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 CHURCH ST FL 19",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065102100",
            "telephone_number": "203-584-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TABISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "CT",
            "license": "21161Y05",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisha Jana Jackson, M.D.
• Jessica Jackson, PA-C
• Kamilah Jackson, M.D.
• Krystal Jackson, APRN
• Rebekah Jackson, PSY.D.
• Tamiko V Jackson, MD
• Van Rieves Jackson IV, D.P.M.
• Andrea Jacobs-Stannard, P.A.
• Harris C Jacobs, MD
• Lauren Ashley Jacobs, M.A.

• Phlebotomy Technician in New Haven, CT
• Providers in New Haven, CT by specialty
• Phlebotomy Technician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.