Healthcare Provider Details

I. General information

NPI: 1326875733
Provider Name (Legal Business Name): JACOB SOSINSKI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E MAIN ST
SOUTH AMHERST OH
44001-2815
US

IV. Provider business mailing address

203 E MAIN ST
SOUTH AMHERST OH
44001-2815
US

V. Phone/Fax

Practice location:
  • Phone: 440-328-7226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: