Provider Demographics
NPI:1528042827
Name:COHAN, JEROME J (NP)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:J
Last Name:COHAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1018 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1402
Mailing Address - Country:US
Mailing Address - Phone:423-282-3379
Mailing Address - Fax:423-430-6227
Practice Address - Street 1:926 W OAKLAND AVE STE 206
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1445
Practice Address - Country:US
Practice Address - Phone:423-282-3379
Practice Address - Fax:423-430-6227
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN011829363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner