Provider Demographics
NPI:1427662444
Name:SEXTON, JACQUELYN BLISS KATCHUK (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:BLISS KATCHUK
Last Name:SEXTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 ENTERPRISE RD E
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5409
Mailing Address - Country:US
Mailing Address - Phone:727-599-5370
Mailing Address - Fax:
Practice Address - Street 1:4197 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3493
Practice Address - Country:US
Practice Address - Phone:727-786-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF08200527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily