Healthcare Provider Details

I. General information

NPI: 1134062870
Provider Name (Legal Business Name): JACKLYN POTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

5440 LINTON BLVD DELRAY MEDICAL CENTER - FAIR OAKS PAVILION #247
DELRAY BEACH FL
33484-6512
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-4440
  • Fax:
Mailing address:
  • Phone: 561-334-6240
  • Fax: 561-495-3467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: