JACLYN MICHELLE TYO


Address: 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4712
Phone: 9046340640

JACLYN MICHELLE TYO (NPI# 1811950272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811950272
Entity Type Individual
Full Name JACLYN MICHELLE TYO
Other Name JACLYN MICHELLE GOODWIN
Credential PA-C
Practice Address 2627 Riverside Ave Ste 300
Jacksonville
FL 32204-4712
Mailing Address 6500 Bowden Rd Ste 103
Jacksonville
FL 32216-8066
Practice Telephone 9046340640
Practice Fax Number 9046340203
Mailing Telephone 9046340640
Mailing Fax Number 9046340203
Enumeration Date 2006-04-07
Last Update Date 2019-03-21
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
PA9103502 FL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
FL 292340800 05

Office Location

Street Address 2627 RIVERSIDE AVE STE 300
City JACKSONVILLE
State FL
Zip Code 32204-4712

Providers in the same location

NPI Name Taxonomy Address Enumeration
1992306229 Bailee Jordan Croy Physical Therapist 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4717 2020-11-03
1609495936 Cari Broderick Physician Assistant 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4717 2020-04-16
1922310952 Mark Anthony Mathias Physician Assistant 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4712 2010-07-07
1497840326 Mary K Long Physician Assistant 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4717 2006-10-04

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437719853 North Florida Surgeons, Pa Orthopaedic Surgery 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 2019-06-18
1770043531 Manuel Viado Rosas Physical Therapist Bold City Therapy and Wellness LLC, 2054 Park Street, Jacksonville, FL 32204 2019-03-20
1255805172 Tracie Nickole Singh Marriage & Family Therapist 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 2019-01-14
1427548544 Bold City Therapy and Wellness LLC Clinic/Center 2054 Park Street, Jacksonville, FL 32204 2018-05-14
1356883078 Lcn Enterprise, LLC Case Manager/Care Coordinator 1225 W Beaver St Ste 106, Jacksonville, FL 32204 2016-11-11
1073065082 Prosser and Prosser LLC Non-emergency Medical Transport (VAN) 2120 Ernest St, Jacksonville, FL 32204 2016-10-26
1336529817 Nader Daoud Internal Medicine 1 Shircliffway, Jacksonville, FL 32204 2015-06-01
1194119214 Benjamin James Dionne Internal Medicine 2 Shircliff Way Ste 400, Jacksonville, FL 32204 2015-03-26
1598187932 Jamara Stephens Counselor 1225 W Beaver St Ste 205, Jacksonville, FL 32204 2014-01-18
1154743961 Kathleen Jasper Nurse Anesthetist, Certified Registered 2165 Herschel Street, Jacksonville, FL 32204 2014-01-14
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1255858650 John Matthew Dumas Physician Assistant 3640 Newcomb Rd, Jacksonville, FL 32218-1510 2017-08-25
1932432093 Andrew Gibson Physician Assistant 12869 Dunes Ct, Jacksonville, FL 32225-3889 2009-09-08
1871556340 Kevin Michael Cofran Physician Assistant 1838 Mcintosh Pl, Jacksonville, FL 32210-2224 2006-04-07
1912969015 Wendy Elizabeth Ashby Physician Assistant 3639 Darnall Pl, Jacksonville, FL 32217-4215 2006-04-04
1407839616 Jennifer Renee Wren Physician Assistant 1820 Barrs St, Suite 701, Jacksonville, FL 32204-4742 2005-11-22
1962403949 Katherine Elizabeth Stenberg Curry Physician Assistant 841 Prudential Dr, Ufjax - Pediatric Cardiothoracic Surgery, Jacksonville, FL 32207-8329 2005-08-02
1346848173 Marisa Elaine Long Physician Assistant 836 Prudential Dr Ste 1001, Jacksonville, FL 32207-8337 2020-10-14
1235775438 Jacqueline M Evans Physician Assistant 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 2019-11-22
1992363733 Lindsey Allison Baroch Physician Assistant 3627 University Blvd S Ste 550, Jacksonville, FL 32216-7401 2019-06-05
1093291205 Christelle Genis Physician Assistant 1824 King St, Ste 200, Jacksonville, FL 32204 2018-07-11
Find all providers in JACKSONVILLE

Competitor

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City JACKSONVILLE
Zip Code 32204

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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