Healthcare Provider Details

I. General information

NPI: 1104304583
Provider Name (Legal Business Name): BRANDY JO STUFFT APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDY JO EBERLY

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 GEORGETOWN ST NE
EAST CANTON OH
44730-1604
US

IV. Provider business mailing address

4100 GEORGETOWN ST NE
EAST CANTON OH
44730-1604
US

V. Phone/Fax

Practice location:
  • Phone: 330-473-0226
  • Fax: 330-947-5624
Mailing address:
  • Phone: 330-473-0226
  • Fax: 330-947-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023050
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: