| Doctor Name: | JACKLYN REYES PANCRUDO |
| NPI Number: | 1003046962 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | OS11255 |
| Business Practice Address: | 11750 Sw 40th St Miami, FL - 331753530 |
| Business Phone Number: | 5619970821 |
| Business Fax Number: | |
| Mailing Address: | 1875 Nw Corporate Blvd, Suite 270 BOCA RATON |
| State: | FL |
| Postal Code: | 334318542 |
| Phone Number: | 5619970821 |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2009 |
| NPI Last Update Date: | 08/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0200X |
| License Number: | OS11255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |