Provider Demographics
NPI:1316707425
Name:JACKSON, DEANA GISELLE
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:GISELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 CYPRESS TRL APT D208
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-3313
Mailing Address - Country:US
Mailing Address - Phone:561-452-8262
Mailing Address - Fax:
Practice Address - Street 1:3518 CYPRESS TRL APT D208
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-3313
Practice Address - Country:US
Practice Address - Phone:561-452-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235518163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse