Active NPI
Judith Jackson, ARNP
- Family Medicine Physician
- Tampa, FL
National Provider Identifier
1952444721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ARNP1613922
- Practice address
- 13856 N Dale Mabry Hwy
Tampa, FL 33618-2420 - Phone
- (813) 264-1885
- NPI assigned
- Feb 14, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ARNP1613922 | FL | Primary |
Addresses
Primary practice location
13856 N Dale Mabry Hwy
Tampa, FL 33618-2420
Mailing address
4212 Golf Club LN
Tampa, FL 33618-2728
Phone (813) 964-9565
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP1613922 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952444721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4212 GOLF CLUB LN",
"city": "TAMPA",
"state": "FL",
"postal_code": "336182728",
"telephone_number": "813-964-9565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13856 N DALE MABRY HWY",
"city": "TAMPA",
"state": "FL",
"postal_code": "336182420",
"telephone_number": "813-264-1885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JUDITH",
"credential": "ARNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ARNP1613922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.