Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jared A Destackelberg, PA

Individual provider Physician Assistant · NPI 1104136399

Jared A Destackelberg, PA is a Physician Assistant in Ocala, Florida. Qualified in 2010, 16 years ago. Practices with Smh Physician Services Inc, a 774-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
16
Licensed in
FL
In the registry since
2010
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1901 SE 18th Ave Ste 101
Ocala, FL 34471-8215
Phone: (352) 622-3360
Fax: (352) 671-3269
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PAT 9105672 (FL)

Record details

NPI number1104136399
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 21, 2010
Last updated in NPPESOctober 21, 2010
Mailing address1901 Se 18th Ave, Ste 101, Ocala, FL 34471-8215

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Smh Physician Services Inc — 774 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations6 on file with Medicare

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