Healthcare Provider Details

I. General information

NPI: 1962277749
Provider Name (Legal Business Name): JACKLYN HEJEILE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKLYN CLOYD PA-C

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 VILLAGE BLVD STE 202
WEST PALM BEACH FL
33409-1972
US

IV. Provider business mailing address

7405 PARK LANE RD
LAKE WORTH FL
33449-6702
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-9000
  • Fax:
Mailing address:
  • Phone: 561-801-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9117849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: