Provider Demographics
NPI:1790251742
Name:GOMBASKI, JEANNIE (CNP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:GOMBASKI
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 1:75 ARCH ST STE 506
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1434
Mailing Address - Country:US
Mailing Address - Phone:330-375-3894
Mailing Address - Fax:
Practice Address - Street 1:1946 TOWN PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-896-3447
Practice Address - Fax:330-896-9919
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023810363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner