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

Jacqueline H Moder

Individual provider Nurse Practitioner · NPI 1568071777

Jacqueline H Moder is a Nurse Practitioner in Waycross, Georgia. Licensed in Florida and Georgia. Registered with an NPI since 2020.

Licensed in
FL, GA
In the registry since
2020
Specialties on file
2

Practice location Address checks out

1912 Memorial Dr Ste E
Waycross, GA 31501-0989
Phone: (912) 283-7100
Show map & directions

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

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence RN240089 (GA)
Nurse Practitioner Taxonomy 363L00000X · Licence 11006710 (FL)

Record details

NPI number1568071777
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 24, 2020
Last updated in NPPESJuly 24, 2020
Certification dateJuly 24, 2020
Mailing address6115 Cottonwood Ln, Blackshear, GA 31516-5992

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