Provider Demographics
NPI:1427688597
Name:JACKSON, LASHENA (DNP ARNP FNP-BC)
Entity type:Individual
Prefix:DR
First Name:LASHENA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DNP ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 VICTORIA LAKES DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5881
Mailing Address - Country:US
Mailing Address - Phone:904-649-3034
Mailing Address - Fax:
Practice Address - Street 1:9109 BAYMEADOWS RD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1842
Practice Address - Country:US
Practice Address - Phone:904-933-8533
Practice Address - Fax:904-212-4306
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005521261QI0500X, 363L00000X, 363LC1500X, 363LF0000X, 363LP2300X
FL320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty