Provider Demographics
NPI:1144095977
Name:PEREIRA, JACLYN (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 RAVELLA WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2966
Mailing Address - Country:US
Mailing Address - Phone:561-420-5097
Mailing Address - Fax:
Practice Address - Street 1:2701 RAVELLA WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2966
Practice Address - Country:US
Practice Address - Phone:561-420-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily