Healthcare Provider Details

I. General information

NPI: 1821703588
Provider Name (Legal Business Name): JENNIFER ANN PETITT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN NIHART

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

4129 W VALLEY DR
FAIRVIEW PARK OH
44126-1737
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5050
  • Fax:
Mailing address:
  • Phone: 567-204-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: