Provider Demographics
NPI:1528409828
Name:NYE, JENNA L (APN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:NYE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3329
Mailing Address - Country:US
Mailing Address - Phone:216-381-8726
Mailing Address - Fax:
Practice Address - Street 1:14440 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3329
Practice Address - Country:US
Practice Address - Phone:216-381-8726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010434363LF0000X
OHAPRN.CNP.17871363LF0000X
OHNP-17871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041380712OtherSTATE OF ILLINOIS (RN LICENSE)