| NPI | 1962680934 |
|---|---|
| Doing Business As | TAMIKO V JACKSON MD |
| Entity Type | Organization |
| Authorized Contact | ANGEL JACKSON Office Manager 203-906-3854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 0136872) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 0002815) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2008-02-01 |