Provider Demographics
NPI:1427363399
Name:TRASKA, JENNIFER C (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:TRASKA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:WASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3447 MALVERN DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1326
Mailing Address - Country:US
Mailing Address - Phone:330-225-2254
Mailing Address - Fax:
Practice Address - Street 1:12380 PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8444
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11687 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP36662OtherMEDICARE
OH3093165Medicaid