Provider Demographics
NPI:1821122441
Name:JONES, GINA MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:JONES
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 1:1461 CORNERSTONE ST SW
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-8935
Mailing Address - Country:US
Mailing Address - Phone:330-715-8486
Mailing Address - Fax:330-478-3341
Practice Address - Street 1:4048 DRESSLER RD NW
Practice Address - Street 2:SUITE 203
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-478-4132
Practice Address - Fax:330-478-3341
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0357076-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2907457Medicaid
OH05181-RXOtherCERTIFICATE TO PRESCRIBE
OHMJ 1186712OtherDEA LICENSE
OH05181-RXOtherCERTIFICATE TO PRESCRIBE
OHPA 9344461Medicare PIN