Provider Demographics
NPI:1639548654
Name:GUNN, JACLYN ANN (DO)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:GUNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ANN
Other - Last Name:LAZARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2000 FOWLER GROVE BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5050
Mailing Address - Country:US
Mailing Address - Phone:407-614-0528
Mailing Address - Fax:407-614-0529
Practice Address - Street 1:2000 FOWLER GROVE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5050
Practice Address - Country:US
Practice Address - Phone:407-614-0528
Practice Address - Fax:407-614-0529
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine