Healthcare Provider Details

I. General information

NPI: 1376959239
Provider Name (Legal Business Name): JESSICA HUFFMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DAYTON

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 STATE ROUTE 306 STE 100
WILLOUGHBY OH
44094-9248
US

IV. Provider business mailing address

6196 PAINESVILLE WARREN RD
PAINESVILLE OH
44077-9746
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 440-241-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.353185
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.16250
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: