Healthcare Provider Details

I. General information

NPI: 1275370959
Provider Name (Legal Business Name): JENNIFER LYNN WYROCK AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A30
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

754 S CLEVELAND AVE STE 300
MOGADORE OH
44260-2210
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-3295
  • Fax: 216-445-8627
Mailing address:
  • Phone: 330-877-3008
  • Fax: 330-877-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: