MRS. TIFFANY RENAE JACKSON (NPI# 1811470768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811470768 |
| Entity Type | Individual |
| Full Name | MRS. TIFFANY RENAE JACKSON |
| Credential | FNP |
| Practice Address |
10515 Mallard Creek Rd Charlotte NC 28262 |
| Mailing Address |
10515 Mallard Creek Rd Charlotte NC 28262-9785 |
| Practice Telephone | 7045479739 |
| Mailing Telephone | 7045479739 |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
5011180 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10515 Mallard Creek Rd, Charlotte, NC 28262 | 7045479739 | |
| 14130 Shaw Dr, Huntersville, NC 280780625 | 7043016353 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902432875 | Tiffany Jackson | Technician | 712 N Jenison Ave, Lansing, MI 48915-1309 | 2020-03-23 |
| 1336781335 | Tiffany Lashun Jackson | Contractor | 1718 Northside Dr Apt O3, Valdosta, GA 31602-1558 | 2019-10-10 |
| 1073161642 | Tiffany Michelle Jackson | Registered Nurse | 4982 Peppers Ferry Rd, Wytheville, VA 24382-4966 | 2019-08-27 |
| 1245892694 | Tiffany Nicole Jackson | Counselor | 6292 Dyke Rd, Chittenango, NY 13037-9404 | 2019-07-06 |
| 1851875116 | Tiffany Andrea Jackson | Case Manager/Care Coordinator | 1095 Golden Lakes Blvd Apt 913, West Palm Beach, FL 33411-3353 | 2018-09-21 |
| 1992046734 | Tiffany Jackson | Licensed Practical Nurse | 4746 Walford Rd Apt 2, Warrensville Heights, OH 44128-5151 | 2013-03-04 |
| 1871801399 | Tiffany Jan'nelle Jackson | Dentist | 2550 Windmill Ln Ste 145, Henderson, NV 89074-5500 | 2010-09-17 |
| 1619289212 | Tiffany C. Jackson | Massage Therapist | 904 S Main St, Pleasant Grove, UT 84062-3560 | 2010-07-12 |
| 1851613251 | Tiffany Renee Jackson | Contractor | 5533 Litchfield St, Philadelphia, PA 19143-4714 | 2010-02-25 |
| 1942491063 | Tiffany R Jackson | Obstetrics & Gynecology | 7217 Telecom Parkway, Suite 290, Garland, TX 75044 | 2007-08-05 |
| Street Address |
10515 MALLARD CREEK RD |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275503468 | Traci Johnson | Nurse Practitioner | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2006-01-23 |
| 1730797978 | Jessica Ruby | Nurse Practitioner | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2020-07-14 |
| 1083132898 | Ravon Lamont Mckoy | Nurse Practitioner | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2017-08-31 |
| 1821535600 | Taylor Holmes | Nurse Practitioner | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2017-01-31 |
| 1407391733 | Melissa Hanson | Nurse Practitioner | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2016-12-22 |
| 1720533003 | Cvs | Pharmacist | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2016-08-17 |
| 1730428863 | Jennifer Nicole Paloski | Pharmacist | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2013-02-09 |
| 1558655100 | Kala Patel Pai | Pharmacist | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2011-05-31 |
| 1720379357 | Lucy Jiten Majithia | Pharmacist | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2011-04-30 |
| 1538462395 | Karen Michelle Husek | Pharmacist | 10515 Mallard Creek Rd, Charlotte, NC 28262-9785 | 2010-12-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366056913 | Aleta Michelle Johnson | Specialist | 9711 David Taylor Dr., Ste. 145, Charlotte, NC 28262 | 2020-09-01 |
| 1275161580 | Londyn Homecare Agency L.l.c | Home Health | 1914j.n. Place, Charlotte, NC 28262 | 2020-03-31 |
| 1154964914 | Abundant Love Home Care Service LLC | In Home Supportive Care | 1981 J.n. Pease Place, Ste 204, Charlotte, NC 28262 | 2019-10-24 |
| 1104399070 | Nattya S Pilgreen | Prosthetist | 410 E Mccullough Drive, Suite 103, Charlotte, NC 28262 | 2019-01-03 |
| 1114404506 | Laura Ida Anthony-getant | Social Worker | 10130 Mallard Creek Road, Ste 300 #333, Charlotte, NC 28262 | 2018-07-27 |
| 1720573587 | Carolinas Center for Ambulatory Dentistry LLC | Dentist | 8415 Medical Plaza Drice, Charlotte, NC 28262 | 2018-06-25 |
| 1598254799 | Cassandra Faye Harding | Nurse Practitioner | 1905 Jn Pease Place Suite 103, Charlotte, NC 28262 | 2018-05-03 |
| 1669960746 | Michael Riley | In Home Supportive Care | 8301 University Exec Park Dr Ste 120, Charlotte, NC 28262 | 2018-04-25 |
| 1568989804 | Bridget Coomber | Behavior Technician | 8420 University Executive Dr Ste 810, Charlotte, NC 28262 | 2017-08-28 |
| 1073037701 | Toshana Daley | Physical Therapist | 8801 Jm Keynes Blvd, Charlotte, NC 28262 | 2017-08-03 |
| Find all providers in zip 28262 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900268 | Jennifer Marie Wolfe | Nurse Practitioner | 831 E Morehead St Ste 900, Charlotte, NC 28202-2726 | 2020-10-19 |
| 1992312433 | Jean L. Caroline Clippard | Nurse Practitioner | 7149 Wessynton Dr, Charlotte, NC 28226-7548 | 2020-09-29 |
| 1790393676 | Alana Weldon | Nurse Practitioner | 10042 Park Cedar Dr, Charlotte, NC 28210-8916 | 2020-07-16 |
| 1114541455 | Kendra Jackson | Nurse Practitioner | 2809 Coltsgate Rd Ste 100, Charlotte, NC 28211-5583 | 2020-06-02 |
| 1740809599 | Nina Cherry Arnold | Nurse Practitioner | 8914 Cotton Press Rd, Charlotte, NC 28277-6676 | 2020-04-13 |
| 1619509197 | Clinica San Antonio Pllc | Nurse Practitioner | 416 Mccullough Dr Ste 110, Charlotte, NC 28262-4387 | 2020-02-12 |
| 1720626773 | Grace Barrosa Genetiano | Nurse Practitioner | 2503 Roswell Ave Unit 507, Charlotte, NC 28209-1685 | 2019-12-19 |
| 1376181081 | Crystal Delgado Calayag Frantilla | Nurse Practitioner | 4206 Craig Ave, Charlotte, NC 28211-3110 | 2019-12-12 |
| 1962059428 | Jerome Virgil Whitlow II | Nurse Practitioner | 6523 Dillard Ridge Dr, Charlotte, NC 28216-8845 | 2019-08-20 |
| 1053978213 | Katie Lynn Sass | Nurse Practitioner | 7004 Smith Corners Blvd Ste A, Charlotte, NC 28269-3827 | 2019-05-23 |
| Find all providers in CHARLOTTE | ||||
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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.