TIFFANY NICOLE JACKSON
NPI 1164950630
Counselor - Mental Health in Lutz, FL

Q: What is Tiffany Jackson's NPI number?

The NPI number for Tiffany Jackson is 1164950630. It was assigned to this individual provider in the NPPES registry on May 30, 2017.

Q: What is Tiffany Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Tiffany Jackson was last updated on December 9, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 30, 2017PECOS Enrolled

21808 STATE ROAD 54, LUTZ, FL 33549(813) 428-6100 Get Directions Write a Review

NPPES record last updated: December 9, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 9, 2019, May 30, 2017 (2 updates tracked since 2017).

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About Tiffany Nicole Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIFFANY NICOLE JACKSON (NPI 1164950630) is an individual mental health provider in Lutz, Florida, licensed in Florida (MH16981) and active in the NPI registry since May 2017. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164950630

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameTIFFANY NICOLE JACKSON

Location Address21808 STATE ROAD 54Lutz, FL 33549-6923

Mailing AddressPo Box 46421Tampa, FL 33646-0104

Phone(813) 428-6100

Sole ProprietorYes

Enumeration DateMay 30, 2017

Last NPPES UpdateDecember 9, 20192 updates tracked since enumeration

✔ NPI 1164950630 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in FL · MH16981

21808 STATE ROAD 54, Lutz, FL 33549

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Oscar Health Maintenance Organization of Florida and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tiffany Nicole Jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HELEN FANTA MD

Student in an Organized Health Care Education/Training Program