Provider Demographics
NPI:1144756248
Name:BOSTICK, JENNIFER ASHLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ASHLEY
Other - Last Name:SMESKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:36000 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4625
Mailing Address - Country:US
Mailing Address - Phone:440-953-9600
Mailing Address - Fax:440-602-6318
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4625
Practice Address - Country:US
Practice Address - Phone:440-953-9600
Practice Address - Fax:440-602-6318
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014103207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine