Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | LE-00028687 | OH |
NPI | 1629637780 |
---|---|
Provider Name | Mr. Tyler Jacob Jones |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |