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Individual
JACLYN NANNA
Active
Individual
JACLYN NANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
042441
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05072615
—
NY
01
—
J400428220
MEDICARE
NY
Enumeration date
11/09/2017
Last updated
05/29/2018
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