Provider Demographics
NPI:1679170492
Name:JACKSON, BRITTANY JESSICA (NP)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:JESSICA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:JESSICA
Other - Last Name:NEMBHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:735 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1416
Practice Address - Country:US
Practice Address - Phone:404-588-4680
Practice Address - Fax:404-588-4692
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily