Provider Demographics
NPI:1982183554
Name:DEBRUYNE, JACLYN M (CNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:DEBRUYNE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-225-8878
Practice Address - Street 1:553 E MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1216
Practice Address - Country:US
Practice Address - Phone:419-219-7001
Practice Address - Fax:567-316-6462
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.023029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily