Provider Demographics
NPI:1962743351
Name:JACKSON, LADAYSHA L (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LADAYSHA
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W JORDAN ST STE 1J
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1734
Mailing Address - Country:US
Mailing Address - Phone:850-455-1252
Mailing Address - Fax:844-683-8754
Practice Address - Street 1:14 W JORDAN ST STE 1J
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1734
Practice Address - Country:US
Practice Address - Phone:850-455-1252
Practice Address - Fax:844-683-8754
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872968363LF0000X
FLARNP9361683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily