Jared A Destackelberg, PA

NPI #1104136399 in Ocala, Florida

Provider Information

NPI Number: 1104136399
Entity Type: Individual
Name: Jared A Destackelberg, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Oct 21, 2010
Last Updated: Oct 21, 2010

Practice Location

Address: 1901 SE 18TH AVE
Address 2: STE 101
City: Ocala
State: Florida
ZIP Code: 34471-8215
Phone: (352) 622-3360

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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