Healthcare Provider Details

I. General information

NPI: 1407185630
Provider Name (Legal Business Name): FRANKLIN JAY VOSTATEK RPH, MBA, MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

IV. Provider business mailing address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

V. Phone/Fax

Practice location:
  • Phone: 614-886-1673
  • Fax:
Mailing address:
  • Phone: 614-886-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-23895
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.16767-NP
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.16767-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: