Healthcare Provider Details

I. General information

NPI: 1922315845
Provider Name (Legal Business Name): JACALYN MARIE CROSS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 01/31/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OHIOHEALTH BLVD SUITE 260
DELAWARE OH
43015-1495
US

IV. Provider business mailing address

561 W CENTRAL AVE
DELAWARE OH
43015-1410
US

V. Phone/Fax

Practice location:
  • Phone: 740-615-0500
  • Fax: 740-615-0501
Mailing address:
  • Phone: 740-615-1324
  • Fax: 740-615-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11717-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: