Individual provider Active NPI

Jacqueline Jena Maiden, FNP-C

  • Family Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1760940506
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN.342370 Issued in OH
Practice address
1200 S Detroit Ave
Toledo, OH 43614-5903
Phone
(419) 259-2000
NPI assigned
Mar 12, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN.342370 OH Primary

Addresses

Primary practice location

1200 S Detroit Ave
Toledo, OH 43614-5903

Mailing address

1200 S Detroit Ave
Toledo, OH 43614-5903
Phone (419) 487-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20230802001017 OH Order and Referring Only - Nurse Practitioner 3173984598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN.342370OHMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1760940506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S DETROIT AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436145903",
            "telephone_number": "419-487-6300",
            "fax_number": "419-213-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S DETROIT AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436145903",
            "telephone_number": "419-259-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIDEN",
        "first_name": "JACQUELINE",
        "middle_name": "JENA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2023-04-11",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "RN.342370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.