Jacqueline H. Moder

Nurse Practitioner · Waycross, GA

Individual Active NPI

NPI number 1568071777

Practice location

1912 Memorial Dr Ste E
Waycross, GA 31501-0989
Phone
(912) 283-7100

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NPI record

NPI
1568071777
Entity type
Individual (Type 1)
Enumeration date
July 24, 2020
Last updated
July 24, 2020
Certified
July 24, 2020
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Nurse Practitioner Primary 363L00000X RN240089 GA
Nurse Practitioner 363L00000X 11006710 FL

Mailing address

6115 Cottonwood Ln
Blackshear, GA 31516-5992
Phone
(912) 286-4400

About Jacqueline Moder

Jacqueline H. Moder is a healthcare provider registered in the NPI registry with the primary taxonomy Nurse Practitioner (code 363L00000X). The practice location is 1912 Memorial Dr Ste E, Waycross, GA 31501-0989. The NPI number 1568071777 was assigned on July 24, 2020 and the record was last updated on July 24, 2020.

Jacqueline Moder lists 2 licenses in the registry: #RN240089 (GA) for Nurse Practitioner; #11006710 (FL) for Nurse Practitioner. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jacqueline H. Moder?

The NPI number is 1568071777.

What is the phone number of Jacqueline Moder?

The phone number listed for the practice location is (912) 283-7100.

Where is Jacqueline Moder located?

1912 Memorial Dr Ste E, Waycross, GA 31501-0989.

What is the taxonomy code for Jacqueline Moder?

The primary taxonomy code is 363L00000X – Nurse Practitioner; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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