MEDICARE: MRS. JESSICA GITTINGER CPNP-AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0222X	Critical Care Pediatric Nurse Practitioner	COA.17859-NP	OH

General Provider Information

NPI Number	:	1568839819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA GITTINGER CPNP-AC

Provider Business Mailing Address
First Line	:	9871 DUBLIN DR
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3185
Country	:	US
Telephone Number	:	440-655-9513
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	440-655-9513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	02/28/2017

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