Healthcare Provider Details

I. General information

NPI: 1982183554
Provider Name (Legal Business Name): JACLYN M DEBRUYNE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E MANHATTAN BLVD
TOLEDO OH
43608-1216
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-219-7001
  • Fax: 567-316-6462
Mailing address:
  • Phone: 419-221-3072
  • Fax: 419-225-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.023029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: