Individual
JACLYN M NIETZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(321) 841-6444
(407) 650-1307
Mailing address
1414 KUHL AVE # MP38, ORLANDO, FL 32806-2008
(321) 842-4713
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9107172
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008573600
—
FL
Enumeration date
03/27/2013
Last updated
07/27/2022
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