Provider Demographics
NPI:1669652400
Name:GUMUCIO, JESSICA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:GUMUCIO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33355 HEALTH CAMPUS BLVD,
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4404
Mailing Address - Country:US
Mailing Address - Phone:216-445-8442
Mailing Address - Fax:216-636-2634
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2811
Practice Address - Country:US
Practice Address - Phone:216-444-8078
Practice Address - Fax:216-636-2634
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.8880235Z00000X
OHAPRN.CNP.021264363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist