Provider Demographics
NPI:1316583792
Name:ELENZ, JAMIE LYNN (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:ELENZ
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3718
Mailing Address - Country:US
Mailing Address - Phone:330-953-3300
Mailing Address - Fax:866-348-7222
Practice Address - Street 1:1500 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3718
Practice Address - Country:US
Practice Address - Phone:330-953-3300
Practice Address - Fax:866-348-7222
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNO OTHER NUMBERS