Provider Demographics
NPI:1477712404
Name:ROCKWELL, JACLYN FONES (CRNA)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:FONES
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:FONES
Other - Last Name:DOBRZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-533-8500
Practice Address - Fax:530-532-8370
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0030081367500000X
CANA95000163367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA172640Medicare PIN