Provider Demographics
NPI:1306684006
Name:JACKSON, CHRISTINA OLIVIA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:OLIVIA
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 1:6501 ARLINGTON EXPRESSWAY B105 #2247
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-872-7552
Mailing Address - Fax:
Practice Address - Street 1:10775 RUTGERS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7714
Practice Address - Country:US
Practice Address - Phone:904-233-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion