Healthcare Provider Details

I. General information

NPI: 1407781073
Provider Name (Legal Business Name): JACOB R NICHOLSON II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE 201
AKRON OH
44304-1431
US

IV. Provider business mailing address

75 ARCH ST STE 201
AKRON OH
44304-1431
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-7055
  • Fax: 234-312-2301
Mailing address:
  • Phone: 330-375-7055
  • Fax: 234-312-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.389822
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0042452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: