Provider Demographics
NPI:1932292646
Name:NADLER, JACLYN SHERI (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:SHERI
Last Name:NADLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 PLACIDA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4949
Mailing Address - Country:US
Mailing Address - Phone:941-275-1234
Mailing Address - Fax:866-280-9677
Practice Address - Street 1:1861 PLACIDA RD STE 202
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4949
Practice Address - Country:US
Practice Address - Phone:941-275-1234
Practice Address - Fax:866-280-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109567207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1932292646OtherCOASTALMED DPC LLC
NC1932292646OtherBLUE MEDICARE
NC5909454Medicaid
NC2022399Medicare PIN