Jaclyn Victoria Nebzydoski

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0102206234 Issued in VA

Practice address

US Naval Hospital Guam
Farenholt Ave, BLDG 50
Agana Heights, GU 96910

Phone

(671) 344-9340

NPI assigned

Feb 18, 2019

Last updated

Sep 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jaclyn Victoria Gassaway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1043776875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "PSC 455 BOX 208",
            "city": "FPO",
            "state": "AP",
            "postal_code": "965400003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US NAVAL HOSPITAL GUAM",
            "address_2": "FARENHOLT AVE, BLDG 50",
            "city": "AGANA HEIGHTS",
            "state": "GU",
            "postal_code": "96910",
            "telephone_number": "671-344-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEBZYDOSKI",
        "first_name": "JACLYN",
        "middle_name": "VICTORIA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-18",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102206234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "GASSAWAY",
            "middle_name": "VICTORIA",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua Medlin, CRNA
• Matthew Thomas Middendorf, MD
• Frederic Baker Mills IV, MD, MS
• Brenda Sue Morgan, APRN
• Rachelle Bumagat Natividad, RN
• NH Guam (Dod Naval Hospital Guam Pharmacy)
• NH Guam
• NH Guam
• Nathaniel R Novak
• Caitlin Jane Parker, DMD

• Pediatrics Physician in Agana Heights, GU
• Providers in Agana Heights, GU by specialty
• Pediatrics Physician in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.