Provider Demographics
NPI:1699341347
Name:JACKSON, DANIELLE ERIN (FNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ERIN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 HERNDON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6304
Mailing Address - Country:US
Mailing Address - Phone:559-483-9911
Mailing Address - Fax:559-387-5499
Practice Address - Street 1:2131 HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6304
Practice Address - Country:US
Practice Address - Phone:559-483-9911
Practice Address - Fax:559-387-5499
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772506363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care