Healthcare Provider Details

I. General information

NPI: 1710356357
Provider Name (Legal Business Name): JENNIFER ROOT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

1615 N RIVER RD NE STE 1
WARREN OH
44483-2437
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number999742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: