Healthcare Provider Details

I. General information

NPI: 1508776378
Provider Name (Legal Business Name): JASMINE TIERRA MCGINNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

IV. Provider business mailing address

PO BOX 34097
PARMA OH
44134-0797
US

V. Phone/Fax

Practice location:
  • Phone: 216-420-3068
  • Fax:
Mailing address:
  • Phone: 216-420-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: