Mary Halbert Jackson, AGPCNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

11021289 Issued in FL

Practice address

6300 Beach Blvd
Jacksonville, FL 32216-2708

Phone

(904) 724-9202

NPI assigned

Dec 1, 2022

Sex

Female

Sole proprietor

No

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

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

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1679283444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11732 HABROSO LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582104",
            "telephone_number": "904-314-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162708",
            "telephone_number": "904-724-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "HALBERT",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "11021289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynelle Marie Jackson, M.S.
• Makeila Jackson
• Maria Jozette Jackson, APRN
• Mark Jackson, LMT
• Marlania Jackson, MASSAGE THERAPIST
• Mary Katherine Jackson, FNP
• Meliscia Jackson
• Meredith Jackson, APRN
• Michelle E Jackson
• Mikayla Jackson, CAA

• Adult Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.