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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | 292340800 | 05 |
Street Address |
2627 RIVERSIDE AVE STE 300 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32204-4712 |
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 |
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 |
Find all providers in zip 32204 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
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 |
City | JACKSONVILLE |
Zip Code | 32204 |
Please comment or provide details below to improve the information on JACLYN MICHELLE TYO.
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.