DOMINIQUE JACKSON (NPI# 1679000814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679000814 |
| Entity Type | Individual |
| Full Name | DOMINIQUE JACKSON |
| Practice Address |
2309 E 15th St Panama City FL 32405-6345 |
| Mailing Address |
403 E 11th St Panama City FL 32401-3409 |
| Practice Telephone | 8507475599 |
| Mailing Telephone | 8507475599 |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2017-05-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
ARNP9352555 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538629639 | Dominique Jackson | Social Worker | 1521 Gull Rd, Kalamazoo, MI 49048-1640 | 2019-03-23 |
| 1174081822 | Dominique Terence Jackson | Nurse Practitioner | 1791 Alum Creek Dr Ste 100, Columbus, OH 43207 | 2019-03-12 |
| 1184164949 | Dominique Jackson | Student in an Organized Health Care Education/Training Program | 1738 S Tremont St, Oceanside, CA 92054-5309 | 2017-02-27 |
| Street Address |
2309 E 15TH ST |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405-6345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487627782 | Maricel Tejeda-oyola | General Practice | 2309 E 15th St, Panama City, FL 32405-6345 | 2006-02-08 |
| 1184273047 | Michael Thad Owens | Nurse Practitioner | 2309 E 15th St, Panama City, FL 32405-6345 | 2019-09-04 |
| 1619520855 | Charles Flowers | Pharmacist | 2309 E 15th St, Panama City, FL 32405-6345 | 2019-07-17 |
| 1336704196 | Pancare of Florida, Inc | Pharmacy | 2309 E 15th St, Panama City, FL 32405-6345 | 2019-05-07 |
| 1922571066 | Jonathan Almand | Physician Assistant | 2309 E 15th St, Panama City, FL 32405-6345 | 2019-01-10 |
| 1982017604 | Tabitha Nieto | Social Worker | 2309 E 15th St, Panama City, FL 32405-6345 | 2014-06-10 |
| 1598022782 | Rhiannon Melissa Kennedy | Nurse Practitioner | 2309 E 15th St, Panama City, FL 32405-6345 | 2012-04-12 |
| 1528105285 | Cruz Edgardo Pagan Delgado | Family Medicine | 2309 E 15th St, Panama City, FL 32405-6345 | 2007-01-31 |
| 1164462628 | Rosa I Bernier | Emergency Medicine | 2309 E 15th St, Panama City, FL 32405-6345 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932727666 | Daniel Totter | Nurse Practitioner | 4008 Brently Cir, Panama City, FL 32405-4844 | 2020-07-09 |
| 1962023580 | Valorey Jenkins | Nurse Practitioner | 5400 Bayline Dr, Panama City, FL 32404-5492 | 2020-05-05 |
| 1932752276 | Bruce Franklin Ferris Jr. | Nurse Practitioner | 237 E Baldwin Rd Ste 101, Panama City, FL 32405-4463 | 2019-07-16 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1710489182 | Amanda Danielle Mcquagge | Nurse Practitioner | 237 E Baldwin Rd Ste 103, Panama City, FL 32405-4205 | 2018-03-01 |
| 1306347505 | Delinda Bane Melvin | Nurse Practitioner | 7834 Olde Mill Rd, Panama City, FL 32409-4824 | 2018-02-22 |
| 1710492392 | Shiloh Leanne Simmons | Nurse Practitioner | 5668 Joseph Rd, Panama City, FL 32404-5026 | 2017-12-05 |
| 1235537044 | Vanquiece Lashunn Lindsey | Nurse Practitioner | 2910 Cedars Xing, Panama City, FL 32405-6388 | 2014-12-10 |
| 1386916500 | Rachel Denise Spikes | Nurse Practitioner | 2633 Highway 77 Ste A, Panama City, FL 32405-4406 | 2012-02-03 |
| 1861790537 | Brian Keith Welch | Nurse Practitioner | 3228e 15th St, Panama City, FL 32405-7423 | 2011-03-04 |
| Find all providers in PANAMA CITY | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
Please comment or provide details below to improve the information on DOMINIQUE 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.