Active NPI
Fanny Jackson, RDH
- Dental Hygienist
- Palm Springs, FL
National Provider Identifier
1679943245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH23160
- Practice address
- 2601 10TH Ave N
Suite 1000
Palm Springs, FL 33461-3141 - Phone
- (561) 642-1008
- Fax
- (561) 802-3976
- NPI assigned
- Sep 25, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH23160 | FL | Primary |
Addresses
Primary practice location
2601 10TH Ave N
Suite 1000
Palm Springs, FL 33461-3141
Mailing address
38754 State Road 80
Belle Glade, FL 33430-5615
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 |
|---|---|---|---|
| DH23160 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443139200000",
"number": "1679943245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38754 STATE ROAD 80",
"city": "BELLE GLADE",
"state": "FL",
"postal_code": "334305615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 10TH AVE N",
"address_2": "SUITE 1000",
"city": "PALM SPRINGS",
"state": "FL",
"postal_code": "334613141",
"telephone_number": "561-642-1008",
"fax_number": "561-802-3976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "FANNY",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-25",
"last_updated": "2015-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "DH23160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.