Individual
JACLYN LISA OTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-6563
(352) 273-6250
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 273-6563
(352) 273-6250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME112268
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005941600
—
FL
Enumeration date
04/01/2009
Last updated
08/16/2012
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