MEDICARE: JENNIFER MARIE TASSINARI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704223719	MI
2	363LP0200X	Pediatric Nurse Practitioner	4704223719	MI
3	363LP0200X	Pediatric Nurse Practitioner	APRN.CNP.15702	OH

General Provider Information

NPI Number	:	1033273776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE TASSINARI NP

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-444-5037
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # S1-20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-4259
Country	:	US
Telephone Number	:	216-444-5037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	11/11/2021

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