Provider Demographics
NPI:1245898147
Name:YOUNGKIN, JACLYN (FNP-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:YOUNGKIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 S ALTERNATE A1A STE 420
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4063
Mailing Address - Country:US
Mailing Address - Phone:561-743-5580
Mailing Address - Fax:561-743-5595
Practice Address - Street 1:2141 S ALTERNATE A1A STE 420
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-743-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily