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Dericka Jackson
NPI 1700558871 · on the registry since 2021 · sole proprietor
Practice
- Address
- 4440 Bass St
Tampa, FL 33617 - Phone
- (813) 384-1568
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2021-09-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida