Moder, Jacqueline H

Moder, Jacqueline H is an individual health care provider with primary practice located at 1912 Memorial Dr Ste E , Waycross GA 31501-0989. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Moder, Jacqueline H can be contacted via phone (912) 283-7100.

Contact Information

Primary practice address
1912 Memorial Dr Ste E Waycross GA 31501-0989
Phone: (912) 283-7100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 11006710 Florida
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN240089 Georgia

Profile Details

NPI number 1568071777
LBN Legal business name Moder, Jacqueline H
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 24th, 2020
Last updated Jul 24th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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