Active NPI
Raven Jackson
- Personal Care Attendant
- Lake City, FL
National Provider Identifier
1972496347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- License
- CNA-18322
- Practice address
- 1818 SW Leslie GLN
Lake City, FL 32025-1406 - Phone
- (386) 406-7236
- NPI assigned
- Jun 2, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | J250-732-83-834-0 | FL | |
| Personal Care Attendant | 3747P1801X | CNA-18322 | FL | Primary |
Addresses
Primary practice location
1818 SW Leslie GLN
Lake City, FL 32025-1406
Mailing address
1818 SW Leslie GLN
Lake City, FL 32025-1406
Phone (386) 406-7236
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 |
|---|---|---|---|
| CNA-18322 | FL | MD | Personal Care Attendant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748822400000",
"number": "1972496347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1818 SW LESLIE GLN",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320251406",
"telephone_number": "386-406-7236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1818 SW LESLIE GLN",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320251406",
"telephone_number": "386-406-7236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RAVEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-02",
"last_updated": "2025-06-02",
"certification_date": "2025-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "FL",
"license": "J250-732-83-834-0",
"primary": false
},
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "FL",
"license": "CNA-18322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.