Healthcare Provider Details

I. General information

NPI: 1821924705
Provider Name (Legal Business Name): JERRY CERVANTES APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N HOWARD ST
SABINA OH
45169-1151
US

IV. Provider business mailing address

10547 MONTGOMERY RD STE 700
MONTGOMERY OH
45242-4418
US

V. Phone/Fax

Practice location:
  • Phone: 937-807-4640
  • Fax:
Mailing address:
  • Phone: 513-939-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: