EILEEN JACKSON (NPI# 1295811511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295811511 |
| Entity Type | Individual |
| Full Name | EILEEN JACKSON |
| Credential | ACNP-BC, CRNFA |
| Practice Address |
11957 E Summer Trl Tucson AZ 85749-9313 |
| Mailing Address |
Po Box 32500 Tucson AZ 85751-2500 |
| Practice Telephone | 5204448940 |
| Practice Fax Number | 5207606690 |
| Mailing Telephone | 5204448940 |
| Mailing Fax Number | 5207606690 |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2018-12-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
RN-075070 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 163WR0006X |
Registered Nurse Specialization: Registered Nurse First Assistant |
RN-075070 | AZ | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS | 918849 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518906320 | Eileen Keenan Jackson | Family Medicine | 51 E Main St., Moroni, UT 84646 | 2006-06-06 |
| 1124555271 | Eileen Jackson | Nurse Practitioner | 650 Commack Rd, Commack, NY 11725-5404 | 2017-05-20 |
| Street Address |
11957 E SUMMER TRL |
| City | TUCSON |
| State | AZ |
| Zip Code | 85749-9313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194197400 | Kristin Palmer | Specialist | 9006 E Eagle Place, Tucson, AZ 85749 | 2015-10-26 |
| 1417349028 | Intermountain Centers for Human Develoment Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8851 East Tanque Verde, Tucson, AZ 85749 | 2015-02-19 |
| 1659776557 | Mahmoud Moghaddami | Nurse Practitioner | 1075 E Ft Lowell, Tucson, AZ 85749 | 2014-11-04 |
| 1255632295 | John Leroy Kallmeyer, M.d. | Obstetrics & Gynecology | 11122 E. Rusty Spur Pl., Tucson, AZ 85749 | 2010-11-08 |
| 1861708547 | Nancy H Mcgibbon | Physical Therapist | 8920 E. Woodland Rd, Tucson, AZ 85749 | 2010-08-19 |
| 1366773103 | Lee J Weisbard | Pharmacist | 9115 E Tanque Verde Road, Tucson, AZ 85749 | 2010-01-19 |
| 1568612869 | Southwest Surgical Services | Specialist/Technologist, Other | 12125 E. Quesada Place, Tucson, AZ 85749 | 2008-09-23 |
| 1841456589 | David Dietz | Counselor | 1795 W. Drexel, Tucson, AZ 85749 | 2008-08-01 |
| 1124203682 | Marilou Errazo-searles | Registered Nurse | 11109 E Tanque Verde Rd, Tucson, AZ 85749 | 2008-01-03 |
| 1427142074 | Rgl Development, LLC | Assisted Living Facility | 9050 E Tanque Verde Road, Tucson, AZ 85749 | 2006-10-03 |
| Find all providers in zip 85749 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226989 | Hillary Lamar | Nurse Practitioner | 3500 N Sabino Canyon Rd Unit 59, Tucson, AZ 85750-6141 | 2020-08-21 |
| 1437614476 | Betty Jo Hensley | Nurse Practitioner | 1650 E Perimeter Way, Tucson, AZ 85706-6079 | 2019-02-04 |
| 1457830192 | Jeremiah Opiniano Ramirez-damilig | Nurse Practitioner | Southern Arizona Va Healthcare System 3601 S 6th Avenue, Tucson, AZ 85723-0001 | 2018-08-13 |
| 1750836219 | Brenda Mitchell | Nurse Practitioner | 3375 N Campbell Ave, Tucson, AZ 85719-2306 | 2016-08-24 |
| 1851637128 | Andrew Peckham | Nurse Practitioner | 5433 E 8th St, Tucson, AZ 85711-3108 | 2012-12-14 |
| 1215290267 | Francisco Javier Carrillo | Nurse Practitioner | 2990 N Swan Rd Ste 227, Tucson, AZ 85712-6025 | 2012-06-22 |
| 1851615710 | Independent First Assist Inc. | Nurse Practitioner | 10129 E Rio De Oro Dr, Tucson, AZ 85749-8117 | 2010-03-22 |
| 1104002633 | Laura Dawn Mcree | Nurse Practitioner | 5463 N Stonehouse Pl, Tucson, AZ 85750-9674 | 2008-01-15 |
| 1669673638 | Kristie Walker Fry | Nurse Practitioner | 445 N Silverbell Rd Ste 202, Tucson, AZ 85745-2686 | 2007-05-29 |
| 1972620318 | Aura Leaf Kaila Edmondson | Nurse Practitioner | 5390 E Erickson Dr, Tucson, AZ 85712 | 2007-03-22 |
| Find all providers in TUCSON | ||||
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| 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.