Provider Demographics
NPI:1922450261
Name:FAST, JAMIE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:FAST
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:MAKARIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:10844 SPERRY RD
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5179
Mailing Address - Country:US
Mailing Address - Phone:440-221-4368
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:M43
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019403363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care