Provider Demographics
NPI:1407133697
Name:GROVE, JESSICA R (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:GROVE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:ECHELBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1913 BELVOIR DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2801
Mailing Address - Country:US
Mailing Address - Phone:419-787-9829
Mailing Address - Fax:
Practice Address - Street 1:1913 BELVOIR DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2801
Practice Address - Country:US
Practice Address - Phone:419-787-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056949Medicaid