Provider Demographics
NPI:1962175265
Name:JACKSON, KIMBERLY L (RN, IPC M ED, CIC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, IPC M ED, CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 NW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2800
Mailing Address - Country:US
Mailing Address - Phone:954-707-8000
Mailing Address - Fax:
Practice Address - Street 1:2881 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-2800
Practice Address - Country:US
Practice Address - Phone:954-707-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9475222163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control