Provider Demographics
NPI:1790271088
Name:TEBBE, JODI K (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:TEBBE
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 DIRKSEN RD
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9775
Mailing Address - Country:US
Mailing Address - Phone:419-953-7351
Mailing Address - Fax:
Practice Address - Street 1:801 PRO DR STE A
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3301
Practice Address - Country:US
Practice Address - Phone:419-586-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.019382364SG0600X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health