Provider Demographics
NPI:1821330937
Name:GARUCCIO, JESSICA R (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:GARUCCIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-844-5595
Mailing Address - Fax:216-844-5522
Practice Address - Street 1:1000 AUBURN DR # 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4317
Practice Address - Country:US
Practice Address - Phone:216-844-5595
Practice Address - Fax:216-844-5522
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.003710OtherLICENSE
OH0081990Medicaid
OH0081990Medicaid