Healthcare Provider Details

I. General information

NPI: 1700263746
Provider Name (Legal Business Name): JACLYN RINI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

IV. Provider business mailing address

2600 BRUCE B DOWNS BLVD
WESLEY CHAPEL FL
33544-9207
US

V. Phone/Fax

Practice location:
  • Phone: 800-828-0898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108634
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: