Provider Demographics
NPI:1053916528
Name:THUMAN, JACLYN (APRN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:THUMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DUNCAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-7921
Mailing Address - Country:US
Mailing Address - Phone:386-631-5047
Mailing Address - Fax:
Practice Address - Street 1:1540 MEMBER LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1215
Practice Address - Country:US
Practice Address - Phone:865-579-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010333363LF0000X
TN0000032233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily