Healthcare Provider Details

I. General information

NPI: 1215453956
Provider Name (Legal Business Name): ADVANCED PRACTICE OF COLUMBUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 CLIME RD N
COLUMBUS OH
43228-3403
US

IV. Provider business mailing address

1328 FAIRWAY DR
GROVE CITY OH
43123-8458
US

V. Phone/Fax

Practice location:
  • Phone: 614-276-4400
  • Fax:
Mailing address:
  • Phone: 614-218-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15913
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.302908
License Number StateOH

VIII. Authorized Official

Name: MS. JENNIFER LYNN BIDDLE
Title or Position: CERTIFIED NURSE PRACTITIONER
Credential: FNP
Phone: 614-218-3105