Healthcare Provider Details

I. General information

NPI: 1700268018
Provider Name (Legal Business Name): JENNIFER HANNON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 BETHEL RD STE.203/204
COLUMBUS OH
43220-2773
US

IV. Provider business mailing address

1161 BETHEL RD STE.203/204
COLUMBUS OH
43220-2773
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-0350
  • Fax: 614-459-0355
Mailing address:
  • Phone: 614-459-0350
  • Fax: 614-459-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.17385-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: