Healthcare Provider Details

I. General information

NPI: 1659878304
Provider Name (Legal Business Name): JENNIFER LYN CULLISON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. VINCENT MEDICAL CENTER 2213 CHERRY STREET, ACC , 1ST FLOOR
TOLEDO OH
43608
US

IV. Provider business mailing address

7101 S PADRE ISLAND DR
CORPUS CHRISTI TX
78412-4913
US

V. Phone/Fax

Practice location:
  • Phone: 847-445-0928
  • Fax:
Mailing address:
  • Phone: 361-761-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT1674
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS18912
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.014438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: