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Dr. Lastasha R Jackson, CRNP
Family Nurse Practitioner in Woodlyn, Pennsylvania
NPI 1356911325

Lastasha R Jackson is a Family Nurse Practitioner based in Norristown, PA and is specialized in Family. Lastasha R Jackson practices in Woodlyn, PA and has the professional credentials of CRNP. The NPI Number for Lastasha R Jackson is 1356911325 and holds a License No. SP022131 (Pennsylvania).

The current practice location address for Lastasha R Jackson is 215 Bullens Ln, Woodlyn, PA and can be reached out via phone at 484-416-0769.

Location: 215 Bullens Ln, Woodlyn, PA, 19401-5407
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1356911325
Provider Name
Lastasha R Jackson
Credential
CRNP
Provider Entity Type
Individual
Gender
Female
Address
215 Bullens Ln, Woodlyn, PA, 19401-5407
Phone Number
484-416-0769
Fax Number
Provider Enumeration Date
06/30/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
215 Bullens Ln
City
Woodlyn
State
Pennsylvania
Zip
19094-2001
Phone Number
484-416-0769
Fax Number
person
Provider Business Mailing Address Details
Address
215 Bullens Ln
City
Woodlyn
State
Pennsylvania
Zip
19094-2001
Phone Number
484-416-0769
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
SP022131 (Pennsylvania)
Definition
Definition to come...
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