JULLIET JACKSON NPI 1922438464

NPI Information

  • NPI: 1922438464
  • Provider Name: JULLIET JACKSON
  • Classification: Custodial Care Facility - 311ZA0620X
  • Specialization: Adult Care Home
  • Entity Type: Individual
  • Address: 17345 EDGEWATER DR
    PORT CHARLOTTE, FL
    ZIP 33948
  • Phone: (941) 766-0175

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NPI Details

Julliet Jackson is an adult care home custodial care facility in Port Charlotte, FL. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. Julliet Jackson NPI is 1922438464. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

17345 EDGEWATER DR
PORT CHARLOTTE, FL
ZIP 33948-343
Phone: (941) 766-0175

The enumeration date for this NPI number is 11/20/2013 and was last updated on 11/20/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care Home6905617FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1142038100MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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