Provider Demographics
NPI:1457836405
Name:MIZE, JENNIFER ANNE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:MIZE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1677
Mailing Address - Country:US
Mailing Address - Phone:440-960-4416
Mailing Address - Fax:440-960-4417
Practice Address - Street 1:3600 KOLBE RD STE 205
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1677
Practice Address - Country:US
Practice Address - Phone:440-960-4416
Practice Address - Fax:440-960-4417
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily