Individual ProviderJacklyn SchafferNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2514 E Dupont Rd Ste 100, Fort Wayne, IN 46825-1619(260) 484-8830PECOS EnrollmentBased on the most recent information from CMS, provider Jacklyn Schaffer does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1366846867Provider TypeIndividualFull NameSchaffer, JacklynCredentialNPGenderFemaleSole ProprietorNoEnumeration Date10/14/2014Last Updated5/6/2020Contact InformationPractice LocationPractice Address2514 E Dupont Rd Ste 100, Fort Wayne, IN 46825-1619Phone(260) 484-8830Fax(260) 483-1911Mailing LocationMailing Address2514 E Dupont Rd Ste 100, Fort Wayne, IN 46825-1619Phone(260) 484-8830Fax(260) 483-1911Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71005316AIndianaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense28191291AIndianaProvider IdentifiersIDDescriptionIssuerID0120115DescriptionMedicaidIssuerUnlistedOhioID201273240DescriptionMedicaidIssuerUnlistedIndiana