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Individual

JACLYN WYNN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
6440 W NEWBERRY RD, STE 401, GAINESVILLE, FL 32605-4381
(352) 332-0030
Mailing address
PO BOX 140764, GAINESVILLE, FL 32614-0764
(352) 332-0030

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9107604
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9107604
FL

Other

Enumeration date
11/05/2013
Last updated
11/05/2013
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