Individual
JACLYN ANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-5776
(352) 392-4541
Mailing address
PO BOX 740861, ATLANTA, GA 30374-0861
(904) 819-4539
(904) 819-4906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
APRN11020833
FL
363L00000X
Nurse Practitioner
Primary
APRN11020833
FL
363LF0000X
Family Nurse Practitioner
APRN11020833
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126442300
—
FL
Enumeration date
06/06/2011
Last updated
09/03/2025
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