Provider Demographics
NPI:1871076992
Name:BELLASSAI, JACLYN S (APRN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:S
Last Name:BELLASSAI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 TIDAL BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-4722
Mailing Address - Country:US
Mailing Address - Phone:813-403-4423
Mailing Address - Fax:813-433-3124
Practice Address - Street 1:8416 TIDAL BREEZE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:813-403-4423
Practice Address - Fax:813-433-3124
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP93110008363LP2300X
FLAPRN9311008363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily