Provider Demographics
NPI:1083159784
Name:HEINZ, JENNA (NP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HEINZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 SYLVANIA AVE
Mailing Address - Street 2:BUILDING 2, SUITE A
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-5510
Mailing Address - Country:US
Mailing Address - Phone:419-479-5392
Mailing Address - Fax:
Practice Address - Street 1:7135 SYLVANIA AVE
Practice Address - Street 2:BUILDING 2, SUITE A
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-5510
Practice Address - Country:US
Practice Address - Phone:419-479-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201864Medicaid
OHH284080Medicare PIN