Provider Demographics
NPI:1174276877
Name:HERBST, JACLYN M (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:HERBST
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ALEXANDRIA CIR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7075
Mailing Address - Country:US
Mailing Address - Phone:989-701-0022
Mailing Address - Fax:
Practice Address - Street 1:128 ALEXANDRIA CIR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7075
Practice Address - Country:US
Practice Address - Phone:989-701-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028349363LG0600X, 363LA2200X, 363LA2100X
MI4704311381363LA2100X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care