MEDICARE: JACLYN BRYAN WOZNIUK ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	19171	SC

General Provider Information

NPI Number	:	1710381249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN BRYAN WOZNIUK ANP-BC

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	1400 HOSPITAL DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3255
Country	:	US
Telephone Number	:	843-884-1341
Fax Number	:	843-884-1345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	01/28/2021

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