Active NPI
Jenice Antoinette Jackson
- Registered Nurse
- Arcadia, FL
National Provider Identifier
1619748019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN9637641
- Practice address
- 706 Bond St
Arcadia, FL 34266-3012 - Phone
- (863) 244-9112
- NPI assigned
- Jan 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN9637641 | FL | Primary |
Addresses
Primary practice location
706 Bond St
Arcadia, FL 34266-3012
Mailing address
706 Bond St
Arcadia, FL 34266-3012
Phone (863) 244-9112
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
| License | State | Type | Specialty |
|---|---|---|---|
| RN9637641 | FL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705276800000",
"number": "1619748019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 BOND ST",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342663012",
"telephone_number": "863-244-9112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "706 BOND ST",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342663012",
"telephone_number": "863-244-9112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENICE",
"middle_name": "ANTOINETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-15",
"last_updated": "2024-01-15",
"certification_date": "2024-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN9637641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcadia, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.