Healthcare Provider Details

I. General information

NPI: 1790585578
Provider Name (Legal Business Name): THOMAS JOHN DUFFY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL STE B
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 234-375-0359
  • Fax: 330-758-3282
Mailing address:
  • Phone: 330-729-8146
  • Fax: 220-965-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038613
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: