DEREK C JACKSON PA
NPI 1811979123
Physician Assistant - Medical in Orlando, FL
About Derek C Jackson Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEREK C JACKSON PA (NPI 1811979123) is an individual medical provider in Orlando, Florida, licensed in Florida (PA9101356) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Derek C Jackson Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
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.
ORLANDO, FL 32803
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Derek Jackson's NPI number?
The NPI number for Derek Jackson is 1811979123. It was assigned to this individual provider in the NPPES registry on November 14, 2005.
Where is Derek Jackson located?
Derek Jackson practices at 601 E Rollins St, Orlando, FL 32803. The listed phone number is (407) 303-5600.
What is Derek Jackson's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Derek Jackson enrolled in Medicare?
Yes. Derek Jackson is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Derek Jackson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Derek C Jackson, PA · NPI 1811979123
Medical physician in Orlando, Florida. Individual provider, active in the CMS NPPES registry since November 14, 2005.
## Identity
- **NPI:** 1811979123 (Entity type: Individual)
- **Enumerated:** November 14, 2005
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **State license:** PA9101356 (Florida)
- **Sole proprietor:** No
## Practice location
- **Address:** 601 E ROLLINS ST, Orlando, FL 32803-1248
- **Phone:** (407) 303-5600
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Medicare UPIN P01895
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Source: [NPI Profile](https://npiprofile.com/npi/1811979123) · Data from the CMS NPPES public registry.