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NPI Code Detail

MEDICARE: JENNIFER ANN PETITT CNP

MEDICARE: JENNIFER ANN PETITT 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
1363L00000XNurse PractitionerAPRN.CNP.026648OH

General Provider Information

NPI Number : 1821703588
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN PETITT CNP
Provider Business Mailing Address
First Line : 4129 W VALLEY DR
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-1737
Country : US
Telephone Number : 567-204-0390
Fax Number :
Provider Business Practice Location Address
First Line : 1810 W 25TH ST UNIT 1
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-3184
Country : US
Telephone Number : 216-685-9975
Fax Number : 216-685-9976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2023
Last Update Date : 01/18/2023

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