Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Deangelo Jackson, NURSEPRACTITIONER

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1821879958

Michael Deangelo Jackson, NURSEPRACTITIONER is a Nurse Practitioner in Long Beach, California. Qualified in 2023, 3 years ago. Practices with Community Research Foundation Inc, a 64-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2023
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Practice location Address checks out

333 W Broadway Ste 310
Long Beach, CA 90802-4438
Phone: (562) 491-6465
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1061 Tierra Del Rey Ste 200, Chula Vista, CA 91910-7881 — (855) 501-1004
  • 1201 Morena Blvd Ste 100, San Diego, CA 92110-3814 — (619) 398-0355

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95027684 (CA)

Record details

NPI number1821879958
Entity typeIndividual (Type 1)
GenderMale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedOctober 13, 2023
Last updated in NPPESApril 13, 2026
Certification dateApril 13, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Community Research Foundation Inc — 64 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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