Provider Demographics
NPI:1528832581
Name:JACKSON, ROBIN LATONIA
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LATONIA
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 1:26 FARMHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1609
Mailing Address - Country:US
Mailing Address - Phone:267-968-1598
Mailing Address - Fax:
Practice Address - Street 1:26 FARMHOUSE RD FL 1
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1609
Practice Address - Country:US
Practice Address - Phone:267-968-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health