Healthcare Provider Details

I. General information

NPI: 1366992356
Provider Name (Legal Business Name): JACLYN MICHELLE HAMLIN MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN MICHELLE DICKMAN RN BSN

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HERNDON PKWY
HERNDON VA
20170-5276
US

IV. Provider business mailing address

648 BURNSIDE TER SE
LEESBURG VA
20175-8936
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-1505
  • Fax:
Mailing address:
  • Phone: 703-400-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1164664
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017143446
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174217
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001237651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: