Healthcare Provider Details

I. General information

NPI: 1053252098
Provider Name (Legal Business Name): SOFIA ROSE DURINA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BOARDMAN CANFIELD RD STE I
BOARDMAN OH
44512-4748
US

IV. Provider business mailing address

615 BOARDMAN CANFIELD RD STE I
BOARDMAN OH
44512-4748
US

V. Phone/Fax

Practice location:
  • Phone: 330-559-7092
  • Fax:
Mailing address:
  • Phone: 330-559-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0042103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: