Provider Demographics
NPI:1124290937
Name:CHERRY, JACLYN MICHELLE (RN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MICHELLE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BROMLEY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1375
Mailing Address - Country:US
Mailing Address - Phone:302-256-0653
Mailing Address - Fax:
Practice Address - Street 1:100 CLAYTON STREET, SUITE 500
Practice Address - Street 2:PULMONARY ASSOCIATES
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-656-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN557986163W00000X
DEL1-0030704163W00000X
DELZ-0000113363L00000X
PASP009771363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner