Provider Demographics
NPI:1275067670
Name:ROOF, JOHN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROOF
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 HIGH ST NW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-1134
Mailing Address - Country:US
Mailing Address - Phone:330-705-2294
Mailing Address - Fax:
Practice Address - Street 1:1761 BEALL AVE STE 3A
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-202-5700
Practice Address - Fax:330-202-5701
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF02170860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224745Medicaid