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

Mr. Brian John Jackson, PA

Individual provider Physician Assistant · NPI 1083198659

Mr. Brian John Jackson, PA is a Physician Assistant in Lehigh Acres, Florida. Qualified in 2018, 8 years ago. Practices with Intermountain Medical Group Grand Junction, LLC, a 299-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
8
Licensed in
FL
In the registry since
2018
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

391 Lee Blvd Ste 300
Lehigh Acres, FL 33936-4973
Phone: (239) 369-4088
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9111499 (FL)

Record details

NPI number1083198659
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 19, 2018
Last updated in NPPESMarch 14, 2019
Mailing address391 Lee Blvd Ste 300, Lehigh Acres, FL 33936-4973

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Intermountain Medical Group Grand Junction, Llc — 299 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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