Healthcare Provider Details

I. General information

NPI: 1124610753
Provider Name (Legal Business Name): JAIMIE ALYSSE TERRASI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR STE 920
TOLEDO OH
43606-5116
US

IV. Provider business mailing address

2109 HUGHES DR STE 920
TOLEDO OH
43606-5116
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-2650
  • Fax:
Mailing address:
  • Phone: 419-479-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030052
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.447944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: