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General NPI Number Information
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NPI Number | 1265973754
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Entity Type | Individual
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Provider Name | JACALYN JANE MARY HENRY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 16215 S JOG RD STE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2387
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Country | US
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Telephone | 561-303-0013
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Fax | 561-499-3199
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Provider Business Mailing Address
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Address Line | PO BOX 20800
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City | BELFAST
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State | ME
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Zip | 04915-4105
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Country | US
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Telephone | 888-402-7256
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Fax | 888-902-1099
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TL2718
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License Number State | SC
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