Provider Demographics
NPI:1386957553
Name:JACKSON, VICTORIA ELIZABETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 CHRISTOPHER PL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4109
Mailing Address - Country:US
Mailing Address - Phone:850-681-6001
Mailing Address - Fax:850-681-6003
Practice Address - Street 1:2354 CHRISTOPHER PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4109
Practice Address - Country:US
Practice Address - Phone:850-681-6001
Practice Address - Fax:850-681-6003
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5185093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse