| Doctor Name: | JEAN JACKLIN |
| NPI Number: | 1043665094 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | R145434 |
| Business Practice Address: | 900 Ritchie Hwy Suite 203 Severna Park, MD - 211464142 |
| Business Phone Number: | 4108972936 |
| Business Fax Number: | 4107935240 |
| Mailing Address: | 900 Ritchie Hwy, Suite 203 SEVERNA PARK |
| State: | MD |
| Postal Code: | 211464142 |
| Phone Number: | 4108972936 |
| Fax Number: | 4107935240 |
| NPI Enumeration Date: | 04/27/2016 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R145434 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |