Provider Demographics
NPI:1144657263
Name:JACKSON, SHERRI K (APRN)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:K
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2644
Mailing Address - Country:US
Mailing Address - Phone:904-249-3743
Mailing Address - Fax:904-249-2047
Practice Address - Street 1:1891 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2644
Practice Address - Country:US
Practice Address - Phone:904-249-3743
Practice Address - Fax:904-249-2047
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01282504OtherRAIL ROAD MEDICARE
OH0093631Medicaid
KY7100262070Medicaid
OH0093631Medicaid