Provider Demographics
NPI:1255667895
Name:FITZGERALD, JENELL SUZANNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JENELL
Middle Name:SUZANNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6855 SPRING VALLEY DR STE 125
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9374
Mailing Address - Country:US
Mailing Address - Phone:419-389-1444
Mailing Address - Fax:419-407-3515
Practice Address - Street 1:6855 SPRING VALLEY DR STE 125
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9374
Practice Address - Country:US
Practice Address - Phone:419-389-1444
Practice Address - Fax:419-407-3515
Is Sole Proprietor?:No
Enumeration Date:2009-11-01
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10253363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092633Medicaid