MEDICARE: JACLYN GOINS CNP

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	APRN.CNP.019868	OH

General Provider Information

NPI Number	:	1881116416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN GOINS CNP

Provider Business Mailing Address
First Line	:	825 S CABLE RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-3400
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S CABLE RD STE A
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:

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

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	01/12/2026

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