Provider Demographics
NPI:1730332040
Name:ACKERMAN, JENNA RENEE KIRBY (NP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RENEE KIRBY
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933132
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:330-724-5471
Mailing Address - Fax:
Practice Address - Street 1:1400 S ARLINGTON ST UNIT 38
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3771
Practice Address - Country:US
Practice Address - Phone:330-724-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2952701Medicaid
OH2551671OtherPPG MEDICAID GROUP #
OH9338635OtherMEDICARE GROUP #
OHNP30801Medicare PIN
OH1841239274OtherPPG GROUP NPI #
OHNP30801Medicare PIN