Jacqueline Marie Jackson

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

9303641 Issued in FL

Practice address

24267 SW 117TH Ave
Homestead, FL 33032-4404

Phone

(305) 951-8358

NPI assigned

Aug 8, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

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": "1628380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628380800000",
    "number": "1972277317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24267 SW 117TH AVE",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330324404",
            "telephone_number": "305-951-8358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24267 SW 117TH AVE",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330324404",
            "telephone_number": "305-951-8358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-08",
        "last_updated": "2021-08-08",
        "certification_date": "2021-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "9300641",
            "primary": false
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "FL",
            "license": "9303641",
            "primary": false
        },
        {
            "code": "163WI0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infection Control",
            "state": "FL",
            "license": "9303641",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "FL",
            "license": "9303641",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "FL",
            "license": "9303641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leosdeivy Izquierdo Diaz
• Jorge Izquierdo
• Julio Armando Izquierdo, APRN
• J C Molina P a (Sara Home Care)
• Ayaah Jabbar
• Maribel Jacobo Hernandez, APRN
• Jessica Lynn Jacobsen, FNP
• Rosaddy Jaime Frometa
• Maria Jussymi Jaime, MD
• Charlotte A James, LIC.AP.DOM.DNBHE,OMD

• Administrator Registered Nurse in Homestead, FL
• Providers in Homestead, FL by specialty
• Administrator Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; 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.