Jacklyn Elaine Petersen , LPN
Licensed Practical Nurse β’ Holland, OH
1905 Perrysburg Holland Rd
Holland, OH 435289582
This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.
Practice Location & Contact Primary Location
1905 Perrysburg Holland Rd
Holland, OH 435289582
Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.
NPPES lists 1 additional practice-address record in Leipsic, OH. See the list
Source: CMS NPPES NPI Registry, practice location records; release date unavailable.
Listings do not confirm current availability, employment or a shared ownership network.
What Public CMS Data Show
Licensed Practical Nurse: NPPES taxonomy is a reported classification, not proof of board certification.
NPI first issued
2007
The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.
What this does not show: NPI first issued
NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.
Source: CMS NPPES NPI Registry.
Medicare assignment not listed
CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.
Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.
Source: CMS Doctors and Clinicians; Medicare.gov, βDoes your provider accept Medicare as full payment?β
No telehealth indicator
CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.
Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.
Compared with the same specialty in Holland and Ohio
25 active clinicians are listed under Licensed Practical Nurse with a practice address in Holland, OH (12,649 in Ohio).
Addresses are self-reported to NPPES and may be out of date.
Telehealth indicator in Holland
0% of these 25 clinicians have the CMS telehealth indicator.
0% of these 25 clinicians are listed by CMS as accepting Medicare assignment.
Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.
Text: T-MedInfo Β· Report an error.
Specialties & License Numbers Reported to NPPES
Self-certified to NPPES: 2025-06-09NUCC Taxonomy Code: 164W00000X
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
NUCC Taxonomy Code: 164W00000X
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
Secondary Practice Locations
48 W Main St
Leipsic, OH 458561128
Phone: 4199433639
Career & Practice History Timeline
Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status
Registered at 1905 PERRYSBURG HOLLAND RD, HOLLAND, OH 435289582 (Tel: 4193240949)
Registered at 1905 PERRYSBURG HOLLAND RD, HOLLAND, OH 435289582 (Tel: 4193240949)
Recorded as JACKLYN PETERSEN, LPN
NPI status registered as active in NPPES database
Registered at 48 W MAIN ST, LEIPSIC, OH 458561128 (Tel: 4199433639)
Registered at 48 W MAIN ST, LEIPSIC, OH 458561128 (Tel: 4199433639)
Recorded as JACKLYN GARCIA, LPN
Licensed Practical Nurse (license number reported to NPPES: OH PN-110467)
First registered as active Individual Practitioner in NPPES Database.
NPI Administrative Meta
Mailing Address
1905 Perrysburg Holland Rd
Holland, OH 435289582
Phone: 4193240949