Provider Demographics
NPI:1356341366
Name:TWEEDY, JESSICA HOLLEY (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HOLLEY
Last Name:TWEEDY
Suffix:
Gender:
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 639295
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:440-826-0500
Mailing Address - Fax:440-826-0501
Practice Address - Street 1:7251 ENGLE RD STE 402
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3400
Practice Address - Country:US
Practice Address - Phone:440-826-0500
Practice Address - Fax:440-826-0501
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023671363LF0000X
RINPP37299363LF0000X
AZ234921363LF0000X
PASP008522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ29272Medicare UPIN