Healthcare Provider Details

I. General information

NPI: 1316577372
Provider Name (Legal Business Name): JEREMY FORD MSN, APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15609 SHIRLEY AVE
MAPLE HEIGHTS OH
44137-4608
US

IV. Provider business mailing address

15609 SHIRLEY AVE
MAPLE HEIGHTS OH
44137-4608
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-3294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number025926
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number025926
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number025926
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: