Healthcare Provider Details

I. General information

NPI: 1942765953
Provider Name (Legal Business Name): JODI LYNN MARTIN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI LYNN JOHNSON

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20046 WALKER RD
SHAKER HEIGHTS OH
44122-3645
US

IV. Provider business mailing address

20046 WALKER RD
SHAKER HEIGHTS OH
44122-3645
US

V. Phone/Fax

Practice location:
  • Phone: 888-288-4715
  • Fax: 833-260-2594
Mailing address:
  • Phone: 888-288-4715
  • Fax: 833-260-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024171
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.024171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: