Provider Demographics
NPI:1164860292
Name:GROSS, JESSICA L (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 SMITH RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3370
Mailing Address - Country:US
Mailing Address - Phone:330-670-9400
Mailing Address - Fax:330-670-9401
Practice Address - Street 1:3029 SMITH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3370
Practice Address - Country:US
Practice Address - Phone:330-670-9400
Practice Address - Fax:330-670-9401
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH14531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14531OtherLICENSE