MEDICARE: JENNIFER ABOAGYE APRN.CNP

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	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.0038870	OH

General Provider Information

NPI Number	:	1609669621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ABOAGYE APRN.CNP

Provider Business Mailing Address
First Line	:	6174 CAMBRIDGE TRL
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-8757
Country	:	US
Telephone Number	:	513-704-1768
Fax Number	:

Provider Business Practice Location Address
First Line	:	11333 CORNELL PARK DR # 200
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-1813
Country	:	US
Telephone Number	:	513-751-6667
Fax Number	:

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

Provider Enumeration Date	:	05/22/2025
Last Update Date	:	06/11/2025

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