Provider Demographics
NPI:1194370296
Name:STRATTON, JACLYN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MARIE
Last Name:STRATTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:MICALLEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:301 BOUTELL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1512
Mailing Address - Country:US
Mailing Address - Phone:248-496-4254
Mailing Address - Fax:
Practice Address - Street 1:35 W HURON ST STE 400
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2124
Practice Address - Country:US
Practice Address - Phone:877-572-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG06190356363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care