Provider Demographics
NPI:1609016617
Name:HELLER, JENNIFER G (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:HELLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:730 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1934
Mailing Address - Country:US
Mailing Address - Phone:216-361-1223
Mailing Address - Fax:
Practice Address - Street 1:468 E MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1594
Practice Address - Country:US
Practice Address - Phone:234-312-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 10616-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2933099Medicaid
OHH469830Medicare PIN