Healthcare Provider Details

I. General information

NPI: 1508821075
Provider Name (Legal Business Name): ANN TIERNEY JARONSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FLETCHER DRIVE SHCC, RM 245
GAINESVILLE FL
32611-7500
US

IV. Provider business mailing address

ONE UNIVERSITY PLAZA YOUNGSTOWN STATE UNIVERSITY STUDENT COUNSELING
YOUNGSTOWN OH
44555
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-1171
  • Fax: 352-846-1030
Mailing address:
  • Phone: 330-941-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6057
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: