Provider Demographics
NPI:1871291997
Name:BROWN-JACKSON, JULLISA NOELLE
Entity type:Individual
Prefix:
First Name:JULLISA
Middle Name:NOELLE
Last Name:BROWN-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINNERS CIRCLE DR APT 104
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-7430
Mailing Address - Country:US
Mailing Address - Phone:386-265-2310
Mailing Address - Fax:
Practice Address - Street 1:868 GEORGE W ENGRAM BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1859
Practice Address - Country:US
Practice Address - Phone:386-322-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula