MEDICARE: JACLYN S RIEBEN PA-C

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	363A00000X	Physician Assistant	9114843	FL

General Provider Information

NPI Number	:	1972573988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN S RIEBEN PA-C

Provider Business Mailing Address
First Line	:	2505 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4464
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Provider Business Practice Location Address
First Line	:	82 MACK BAYOU LOOP
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-2637
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/04/2026

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Directions to “ JACLYN S RIEBEN PA-C” Practice Location

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