DR. JON C JACKSON (NPI# 1093724551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093724551 |
| Entity Type | Individual |
| Full Name | DR. JON C JACKSON |
| Credential | M.D. |
| Practice Address |
4770 S Ridgewood Ave Port Orange FL 32127-4544 |
| Practice Telephone | 3867610050 |
| Practice Fax Number | 3867611167 |
| Mailing Telephone | 3867610050 |
| Mailing Fax Number | 3867611167 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | ME28054 | FL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | CIGNA | 013 | 01 |
| FL | BLUE CROSS BLUE SHIELD | 64353 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285886051 | Jon R Jackson | Counselor | 337 Fowler St, Roseburg, OR 97470 | 2008-10-10 |
| 1972815934 | Jon Grant Jackson | Pharmacist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2010-07-07 |
| 1760669345 | Jon C Jackson | Psychiatry & Neurology | 2500 North State Street, Jackson, MS 39216 | 2008-01-26 |
| 1598840472 | Jon Gustaf Jackson | Psychiatry & Neurology | 1335 North Dutton Ave, Santa Rosa, CA 95401 | 2006-10-26 |
| 1740254978 | Jon Ryan Jackson | Plastic Surgery | 1890 Sw Health Pkwy, Suite 301, Naples, FL 34109-0473 | 2006-02-14 |
| 1013909118 | Jon Richard Jackson | Internal Medicine | 5000 Hennessy Blvd, Baton Rouge, LA 70808-4375 | 2005-08-16 |
| Street Address |
4770 S RIDGEWOOD AVE |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32127-4544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619433869 | Metcare of Florida, Inc | Internal Medicine | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2019-02-13 |
| 1477064509 | Samantha Hughes | Nurse Practitioner | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2017-10-16 |
| 1154866820 | Natasha Anderson | Nurse Practitioner | 4770 S Ridgewood Ave, Suite 1, Port Orange, FL 32127-4544 | 2017-01-04 |
| 1053861054 | Primary Care of Port Orange | Health Maintenance Organization | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2016-10-13 |
| 1538317383 | Angela K Beech | Physician Assistant | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2008-09-05 |
| 1295910834 | Primary Care Center of Port Orange | Family Medicine | 4770 S Ridgewood Ave, Suite 1, Port Orange, FL 32127-4544 | 2008-01-02 |
| 1134220692 | Sarah Brown | Nurse Practitioner | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918179 | Karen Lugo Morales | Massage Therapist | 1394 Dunlawton Ave, Apartment 505, Port Orange, FL 32127 | 2020-09-30 |
| 1265952568 | Compass Nutrition LLC | Dietitian, Registered | 840 Angelina Court, Port Orange, FL 32127 | 2017-06-27 |
| 1942730544 | Ambili Gopinathan Nair | Nurse Anesthetist, Certified Registered | 6216 Morning Drive, Port Orange, FL 32127 | 2017-06-15 |
| 1649707993 | Jill Lynn Sheldon | Social Worker | 3959 South Nova Road, Suiteb15, Port Orange, FL 32127 | 2017-05-17 |
| 1003350620 | Irene A Zachry | Interpreter | 6239 Yellowstone Dr. Port Orange Fl, Port Orange, FL 32127 | 2016-12-16 |
| 1427460328 | Jonathan Ivan Rodriguez Arocho | Chiropractor | 940 Village Trail, Unit 4-105, Port Orange, FL 32127 | 2014-05-27 |
| 1982015913 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1208 Dunlawton Ave, Port Orange, FL 32127 | 2014-05-13 |
| 1699105288 | Counseling & Consultation, Corp. | Early Intervention Provider Agency | 3959 S. Nova Rd., Suite 14, Port Orange, FL 32127 | 2013-11-18 |
| 1427484773 | Usv Optical Inc. | Technician/Technologist | 1800 Dunlawton Ave., Port Orange, FL 32127 | 2013-09-18 |
| 1104194018 | Jinny E Ruhlman | Marriage & Family Therapist | 4725 Dixie Dr, Ponce Inlet, FL 32127 | 2011-12-06 |
| Find all providers in zip 32127 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538411731 | Roberta Ann Gilmartin | Specialist | 1048 W Samms Ave, Port Orange, FL 32129 | 2012-10-11 |
| 1124310347 | Donna Yonta | Specialist | 3930 Oriole Ave, Port Orange, FL 32127-6518 | 2011-05-05 |
| 1336446723 | John L Kihm | Specialist | 1824 Summer Green Dr, Port Orange, FL 32128-7157 | 2011-02-21 |
| 1891978185 | Sheree Genevieve Urich | Specialist | 1304 Osprey Nest Ln, Port Orange, FL 32128-7160 | 2007-12-10 |
| 1598968554 | Cindy W Vola | Specialist | 2385 Guava Dr, Port Orange, FL 32128-6505 | 2007-06-07 |
| 1649488933 | Tina G Evans | Specialist | 16 Black Jack Cir, Port Orange, FL 32128-6771 | 2007-05-18 |
| 1891776399 | Anthony Carmine Picchiello | Specialist | 3951 South Nova Rd, Port Orange, FL 32127 | 2005-11-10 |
| 1528049327 | Ralph Joseph Zwolinski | Specialist | 5111 S Ridgewood Ave, Suite 102, Port Orange, FL 32127-5169 | 2005-11-09 |
| 1861890790 | Amer Khatib | Specialist | 1690 Dunlawton Ave, Suite 120, Port Orange, FL 32127-8979 | 2014-12-09 |
| 1376816876 | Advanced Endoscopy Centers LLC | Specialist | 1690 Dunlawton Ave, Suite 220, Port Orange, FL 32127-8979 | 2012-02-14 |
| Find all providers in PORT ORANGE | ||||
| City | PORT ORANGE |
| Zip Code | 32127 |
Please comment or provide details below to improve the information on DR. JON C JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.