Provider Demographics
NPI:1689991580
Name:POPOVICH, JAYSIE LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:JAYSIE
Middle Name:LYNN
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 STATE ROUTE #43
Mailing Address - Street 2:SUITE B
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5376
Mailing Address - Country:US
Mailing Address - Phone:330-626-1113
Mailing Address - Fax:
Practice Address - Street 1:9293 STATE ROUTE #43
Practice Address - Street 2:SUITE B
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5376
Practice Address - Country:US
Practice Address - Phone:330-626-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11450-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health