Individual
JARED A DESTACKELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1901 SE 18TH AVE, STE 101, OCALA, FL 34471-8215
(352) 622-3360
(352) 671-3269
Mailing address
1901 SE 18TH AVE, STE 101, OCALA, FL 34471-8215
(352) 622-3360
(352) 671-3269
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAT 9105672
FL
Other
Enumeration date
10/21/2010
Last updated
10/21/2010
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