Provider Demographics
NPI:1871135061
Name:JACKSON, ASHIQUA J (APRN)
Entity type:Individual
Prefix:
First Name:ASHIQUA
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WACKER DR STE 3200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5878
Mailing Address - Country:US
Mailing Address - Phone:773-254-5555
Mailing Address - Fax:
Practice Address - Street 1:200 S WACKER DR STE 3200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5878
Practice Address - Country:US
Practice Address - Phone:773-254-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily