Provider Demographics
NPI:1194456814
Name:GIUSTO, JALYN VICTORIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:VICTORIA
Last Name:GIUSTO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WESTERN WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5645
Mailing Address - Country:US
Mailing Address - Phone:478-737-5540
Mailing Address - Fax:
Practice Address - Street 1:4061 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5039
Practice Address - Country:US
Practice Address - Phone:478-757-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner