Provider Demographics
NPI:1124274774
Name:JACKSON, KAREN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 INDUSTRIAL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7668
Mailing Address - Country:US
Mailing Address - Phone:850-290-8410
Mailing Address - Fax:866-574-6391
Practice Address - Street 1:45 INDUSTRIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7668
Practice Address - Country:US
Practice Address - Phone:850-290-8410
Practice Address - Fax:866-574-6391
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9287293363LA2200X
FLARNP9287293363LA2100X
AL1-087343363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00720964OtherRAILROAD MEDICARE
FLP00720964OtherRAILROAD MEDICARE