Provider Demographics
NPI:1508743477
Name:JANERIC MEDICAL PLLC
Entity type:Organization
Organization Name:JANERIC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:256-652-4882
Mailing Address - Street 1:118 WHEAT RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-2524
Mailing Address - Country:US
Mailing Address - Phone:256-468-9468
Mailing Address - Fax:256-539-7874
Practice Address - Street 1:2308 PANSY ST SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3803
Practice Address - Country:US
Practice Address - Phone:256-533-4377
Practice Address - Fax:256-539-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty