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General NPI Number Information
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NPI Number | 1174276877
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Entity Type | Individual
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Provider Name | JACLYN M HERBST MSN, APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 128 ALEXANDRIA CIR
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City | DELAND
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State | FL
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Zip | 32724-7075
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Country | US
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Telephone | 989-701-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 128 ALEXANDRIA CIR
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City | DELAND
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State | FL
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Zip | 32724-7075
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Country | US
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Telephone | 989-701-0022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11028349
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11028349
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704311381
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN11028349
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704311381
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704311381
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License Number State | MI
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