Provider Demographics
NPI:1659173698
Name:JACKSON, ERIN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 E TRELLIS RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5426
Mailing Address - Country:US
Mailing Address - Phone:480-313-7003
Mailing Address - Fax:
Practice Address - Street 1:1148 E TRELLIS RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-5426
Practice Address - Country:US
Practice Address - Phone:480-313-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ308721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine