Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jaclyn Renee Wallace, NNP-BC

Individual provider Critical Care Neonatal Nurse Practitioner · NPI 1326572801

Jaclyn Renee Wallace, NNP-BC is a Critical Care Neonatal Nurse Practitioner in Atlanta, Georgia. Practices as a sole proprietor. Licensed in Georgia.

Licensed in
GA
In the registry since
2017

Practice location Address checks out

1711 Tullie Cir NE
Atlanta, GA 30329-2305
Phone: (404) 785-5413
Fax: (404) 785-6233
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Critical Care Neonatal Nurse Practitioner (primary) Taxonomy 363LN0005X · Licence RN211895 (GA)

Record details

NPI number1326572801
Entity typeIndividual (Type 1)
GenderFemale
Credentials NNP-BC
Sole proprietorYes
NPI enumeratedApril 12, 2017
Last updated in NPPESApril 12, 2017

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