Healthcare Provider Details

I. General information

NPI: 1477966711
Provider Name (Legal Business Name): JACLYN STEELE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACLYN RIVEROL

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4000
  • Fax:
Mailing address:
  • Phone: 813-870-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberARNP9303604
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberARNP9303604
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberARNP9303604
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberARNP9303604
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9303604
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9303604
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9303604
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9303604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: