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

Miss. Jaclynn Pauline Back, APRN

Individual provider Registered Nurse · NPI 1770835506

Miss. Jaclynn Pauline Back, APRN is a Nurse Practitioner in Newark, Ohio. Qualified in 2012, 14 years ago. Practices with Boulder Care Provider Group PA, a 109-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
14
Licensed in
OH
In the registry since
2012
Specialties on file
2
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

1445 W Main St
Newark, OH 43055-1989
Phone: (513) 834-7063
Fax: (513) 873-1567
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN.CNP.13665 (OH)
Registered Nurse Taxonomy 163W00000X · Licence RN.313249 (OH)

Record details

NPI number1770835506
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN
Sole proprietorYes
NPI enumeratedOctober 3, 2012
Last updated in NPPESOctober 3, 2024
Certification dateOctober 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Boulder Care Provider Group Pa — 109 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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