Provider Demographics
NPI:1891922290
Name:MCINTOSH, JENNA MARIE (AA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:AA
Other - Prefix:MRS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:SARANITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:7757 AUBURN RD STE 15
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9604
Mailing Address - Country:US
Mailing Address - Phone:440-350-0832
Mailing Address - Fax:440-350-0832
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5437
Practice Address - Country:US
Practice Address - Phone:440-350-0832
Practice Address - Fax:440-354-7420
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000150367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3024837Medicaid
OH3024837Medicaid