Provider Demographics
NPI:1538884879
Name:JACKSON, LINDA YVETTE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:YVETTE
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 1:1467 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-1619
Mailing Address - Country:US
Mailing Address - Phone:904-577-2429
Mailing Address - Fax:
Practice Address - Street 1:1467 E 28TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-1619
Practice Address - Country:US
Practice Address - Phone:904-577-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services