Healthcare Provider Details

I. General information

NPI: 1447064480
Provider Name (Legal Business Name): JACLYN ASHLEY ZABOLOTNY DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LILAC DR N STE 140
GOLDEN VALLEY MN
55422-4791
US

IV. Provider business mailing address

2222 LIBERTY GLEN LOOP
SAINT CLOUD MN
56304-4683
US

V. Phone/Fax

Practice location:
  • Phone: 763-465-0500
  • Fax:
Mailing address:
  • Phone: 612-834-8473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13951
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: