Provider Demographics
NPI:1386764272
Name:JACKSON, J. RAKIIBA (CNM)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:RAKIIBA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00804-1317
Mailing Address - Country:US
Mailing Address - Phone:340-777-8804
Mailing Address - Fax:340-774-7392
Practice Address - Street 1:DEPT. OF HEALTH, FAMILY PLANNING PROGRAM, ELAINCO BLDG.
Practice Address - Street 2:EST. CONTANT 78-123
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-5256
Practice Address - Fax:340-774-7392
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VI1143367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife