Provider Demographics
NPI:1962277749
Name:CLOYD, JACKLYN (PA-C)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:CLOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 PARK LANE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-6702
Mailing Address - Country:US
Mailing Address - Phone:561-801-0517
Mailing Address - Fax:
Practice Address - Street 1:12008 S SHORE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6395
Practice Address - Country:US
Practice Address - Phone:561-288-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical