Provider Demographics
NPI:1366992356
Name:HAMLIN, JACLYN MICHELLE (MSN FNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MICHELLE
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:MICHELLE
Other - Last Name:DICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:648 BURNSIDE TER SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8936
Mailing Address - Country:US
Mailing Address - Phone:703-400-5489
Mailing Address - Fax:
Practice Address - Street 1:555 HERNDON PKWY
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5276
Practice Address - Country:US
Practice Address - Phone:703-481-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017143446363LF0000X
VA0001237651163W00000X
VA0024174217363LF0000X
TX1164664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse