Healthcare Provider Details

I. General information

NPI: 1609744895
Provider Name (Legal Business Name): JACLYN E STULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/30/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ARCH ST STE 2A
AKRON OH
44304-1424
US

IV. Provider business mailing address

10265 BOSTON AVE NW
NORTH CANTON OH
44720-4425
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-9617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0040538
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.418203
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: