Healthcare Provider Details

I. General information

NPI: 1245793389
Provider Name (Legal Business Name): JESSICA CARLENE TOMAZIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 COOPER FOSTER PARK RD W
LORAIN OH
44053-4131
US

IV. Provider business mailing address

5800 COOPER FOSTER PARK RD W
LORAIN OH
44053-4131
US

V. Phone/Fax

Practice location:
  • Phone: 440-204-7800
  • Fax:
Mailing address:
  • Phone: 440-204-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35.145427
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.145427
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.145427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: