Provider Demographics
NPI:1417544024
Name:SABIN, JACLYN (RN)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SABIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 SONOMA DR APT 305
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7697
Mailing Address - Country:US
Mailing Address - Phone:413-822-3109
Mailing Address - Fax:
Practice Address - Street 1:15201 SONOMA DR APT 305
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7697
Practice Address - Country:US
Practice Address - Phone:413-822-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9533441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse