Provider Demographics
NPI:1801770359
Name:CROCKETT, JAYLIN KYLE (PA-S)
Entity type:Individual
Prefix:
First Name:JAYLIN
Middle Name:KYLE
Last Name:CROCKETT
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19507 FRENCH LACE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9245
Mailing Address - Country:US
Mailing Address - Phone:904-434-4037
Mailing Address - Fax:
Practice Address - Street 1:350 UT ARCHWAY LANE
Practice Address - Street 2:GRADUATE HEALTH SCIENCES (GHS), 3RD FLOOR, PA MEDICINE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-257-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program