MEDICARE: JENNIFER STAUFFER FNP

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	363LF0000X	Family Nurse Practitioner	COA.16877-NP	OH

General Provider Information

NPI Number	:	1073904520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STAUFFER FNP

Provider Business Mailing Address
First Line	:	PO BOX 746071
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6071
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	733-866-8014

Provider Business Practice Location Address
First Line	:	16888 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2208
Country	:	US
Telephone Number	:	216-810-7159
Fax Number	:	216-920-6286

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	12/02/2020

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