Provider Demographics
NPI:1245716778
Name:PANTON, JACQUELINE SOPHIA (ARNP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SOPHIA
Last Name:PANTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2826
Mailing Address - Country:US
Mailing Address - Phone:305-710-3011
Mailing Address - Fax:
Practice Address - Street 1:6230 SW 25TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2826
Practice Address - Country:US
Practice Address - Phone:305-710-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231265363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health