Healthcare Provider Details

I. General information

NPI: 1982534541
Provider Name (Legal Business Name): JTB MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 FALLBROOK BLVD STE 105
LINCOLN NE
68521-9142
US

IV. Provider business mailing address

2646 W GARFIELD ST
LINCOLN NE
68522-4448
US

V. Phone/Fax

Practice location:
  • Phone: 402-276-5160
  • Fax:
Mailing address:
  • Phone: 402-276-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN TIERNEY
Title or Position: OWNER
Credential:
Phone: 402-276-5160