MEDICARE: JACLYN PEREIRA FNP-BC, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95028125	CA

General Provider Information

NPI Number	:	1144095977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN PEREIRA FNP-BC, APRN

Provider Business Mailing Address
First Line	:	2701 RAVELLA WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2966
Country	:	US
Telephone Number	:	561-420-5097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 RAVELLA WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2966
Country	:	US
Telephone Number	:	561-420-5097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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