Provider Demographics
NPI:1821122441
Name:MODENA, GINA MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:MODENA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:875 N. MUNROE RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:330-715-8486
Mailing Address - Fax:330-375-7499
Practice Address - Street 1:141 N FORGE ST STE 400
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-375-7494
Practice Address - Fax:330-375-7499
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107912086X0206X, 363LA2200X
OH0357076-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05181-RXOtherCERTIFICATE TO PRESCRIBE
OH2907457Medicaid
OHMJ 1186712OtherDEA LICENSE
OH05181-RXOtherCERTIFICATE TO PRESCRIBE
OHPA 9344461Medicare PIN