Healthcare Provider Details

I. General information

NPI: 1033579610
Provider Name (Legal Business Name): JACULYN ZARBACK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

IV. Provider business mailing address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2900
US

V. Phone/Fax

Practice location:
  • Phone: 440-840-4404
  • Fax:
Mailing address:
  • Phone: 440-840-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0031945
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031945
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.157270-M-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: