Provider Demographics
NPI:1104620616
Name:ZINK-PITUSKIN, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ZINK-PITUSKIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S BEACH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4433
Mailing Address - Country:US
Mailing Address - Phone:386-898-6040
Mailing Address - Fax:386-256-2320
Practice Address - Street 1:210 S BEACH ST STE 200
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4433
Practice Address - Country:US
Practice Address - Phone:386-898-6040
Practice Address - Fax:386-256-2320
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHHT-020OtherINFANT TODDLER DEVELOPMENTAL SPECIALIST