Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TANAGRA JACKSON FNP
NPI 1912620022
Nurse Practitioner - Family in Nuevo, CA

Q: What is Tanagra Jackson's NPI number?

The NPI number for Tanagra Jackson is 1912620022. It was assigned to this individual provider in the NPPES registry on September 22, 2022.

Q: What is Tanagra Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Tanagra Jackson was last updated on August 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days 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.

Active since September 22, 2022PECOS Enrolled

30427 DELTA DR, NUEVO, CA 92567(773) 530-5217 Get Directions Write a Review

NPPES record last updated: August 25, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Aug 25, 2026, Aug 3, 2024, Sep 22, 2022 (3 updates tracked since 2022).

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About Tanagra Jackson Fnp NPPES

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

TANAGRA JACKSON FNP (NPI 1912620022) is an individual family provider in Nuevo, California, licensed in Tennessee (32937) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1912620022

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameTANAGRA JACKSONCredential: FNP

Location Address30427 DELTA DRNuevo, CA 92567-9470

Mailing Address30427 Delta DrNuevo, CA 92567-9470 · (773) 530-5217

Phone(773) 530-5217

Sole ProprietorNo

Enumeration DateSeptember 22, 2022

Last NPPES UpdateAugust 25, 20263 updates tracked since enumeration

NPPES CertifiedAugust 25, 2026

✔ NPI 1912620022 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in TN · 32937✔ Licensed in CA · 95021964

Also ListedNurse PractitionerTaxonomy 363L00000X · License 95021964 (CA)

30427 DELTA DR, Nuevo, CA 92567

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Secondary Practice Locations 2

Location 1200 C StPatterson, CA 95363-2701 · Phone (209) 722-4842

Location 2108 Courtright RdMartin, TN 38237-1607 · Phone (731) 281-4183

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tanagra Jackson Fnp 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92567 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$104.64 typical visit price

range $19.37 – $146.42

Typical copayment $26.16 (range $4.84 – $36.60)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

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

ST AGNES NON-EMERGENCY MEDICAL TRANSPORTATION LLC

Transportation Network Company

30427 DELTA DR
NUEVO, CA 92567

Riverside County (562) 419-5050

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 Tanagra Jackson's NPI number?

The NPI number for Tanagra Jackson is 1912620022. It was assigned to this individual provider in the NPPES registry on September 22, 2022.

Where is Tanagra Jackson located?

Tanagra Jackson practices at 30427 Delta Dr, Nuevo, CA 92567. The listed phone number is (773) 530-5217.

What is Tanagra Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Tanagra Jackson enrolled in Medicare?

Yes. Tanagra Jackson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tanagra Jackson was last updated on August 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days 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.