Jaclyn Wynn, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9107604 Issued in FL

Practice address

6440 W Newberry Rd
Ste 401
Gainesville, FL 32605-4381

Phone

(352) 332-0030

NPI assigned

Nov 5, 2013

Last updated

Nov 5, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shands-Solantic Joint Venture LLCGroup PAC ID 4183764178, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shands/Solantic Joint Venture, LLC

  • Urgent Care Clinic/Center
  • Gainesville, FL
  • NPI 1558595223
  Medicare reassignment Care Compare group
• Carespot of Orlando Hsi Urgent Care LLC

  dba CareSpot Urgent Care / CareSpot - Clermont

  • Urgent Care Clinic/Center
  • Orlando, FL
  • NPI 1306367503
  Medicare reassignment
• Florida Neurosurgical Associates PA

  • Neurological Surgery Physician
  • Gainesville, FL
  • NPI 1639392004
  Medicare reassignment
• Clover Emergency Physicians LLC

  • Emergency Medicine Physician
  • St Petersburg, FL
  • NPI 1891744736
  NPD (past)

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1356770887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140764",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326140764",
            "telephone_number": "352-332-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 W NEWBERRY RD",
            "address_2": "STE 401",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054381",
            "telephone_number": "352-332-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "JACLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-05",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107604",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tameka Lashiva Wyckoff, ARNP
• Hayden Tyler Wygant
• David Cole Wymer, MD
• James P Wymer, MD
• Cynthia Wynn-Graves
• James Lawrence Wynn, M.D.
• Suzanne Margaret Wynn, L.M.T.
• Tung T Wynn, M.D.
• James W. Wynne, MD
• Latanya Faye Wynnhall

• Surgical Physician Assistant in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.