JACLYN ANNE WAGNER (FNP) – Nurse Practitioner, NPI 1720372964
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,652 NURSE PRACTITIONER in GA
Provider Addresses for JACLYN ANNE WAGNER (FNP)
165 WOODBRIDGE PL
BROOKS, GA 302051546
Phone: (904) 864-6568
Type: Mailing
1255 HIGHWAY 54 W
FAYETTEVILLE, GA 302144526
Phone: (770) 719-7911
Type: Location
1255 Highway 54 W
Fayetteville, GA 302144526
Phone: (770) 719-7911
Type: Location
110 Health Park Blvd
Saint Augustine, FL 320865776
Phone: (904) 823-3401
Fax: (904) 829-8649
Type: Location
PO BOX 740861
ATLANTA, GA 303740861
Phone: (904) 819-4539
Fax: (904) 819-4906
Type: Mailing
1600 SW ARCHER RD
GAINESVILLE, FL 326105776
Phone: (352) 392-4541
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 23 Open Payments records for all available years, with a total value of $473.
Total Amount is formed as General ($473) + Research ($0) + Ownership ($0) = $473.
Last reported payment date: 2024-08-29 • Largest payer in this snapshot: ABBVIE INC. ($94).
Total Amount
$473
General + Research + Ownership
Payments
23
Total payment records
General Amount
$473
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $94 |
| Novo Nordisk Inc | $50 |
| AstraZeneca Pharmaceuticals LP | $46 |
| Inspire Medical Systems, Inc. | $36 |
| Lundbeck LLC | $34 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-09-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110721000256 | I | Nurse Practitioner | GA | TBD |
| I20230918003983 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 38 | 36 | $0 |
Insurance plans in this area (ZIP 30205)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | FL | |
| - | FL | |
| - | FL | |
| Nurse Practitioner | GA | |
| Physician Assistant | FL | |
| Physician Assistant | FL | |
| - | FL | |
| - | FL | |
| Emergency Medicine | GA | |
| Nurse Practitioner | FL |
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