Provider Demographics
NPI:1023554623
Name:FORD, JOCELYNN (STNA)
Entity Type:Individual
Prefix:
First Name:JOCELYNN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 ANSEL RD
Mailing Address - Street 2:#59
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4187
Mailing Address - Country:US
Mailing Address - Phone:216-551-3781
Mailing Address - Fax:
Practice Address - Street 1:1560 ANSEL RD
Practice Address - Street 2:#59
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4187
Practice Address - Country:US
Practice Address - Phone:216-551-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401441300912376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide