Provider Demographics
NPI:1154726214
Name:MYERS, JOVI-ANNE C (APN-CNP)
Entity type:Individual
Prefix:MRS
First Name:JOVI-ANNE
Middle Name:C
Last Name:MYERS
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2497
Mailing Address - Country:US
Mailing Address - Phone:847-570-2714
Mailing Address - Fax:847-570-1436
Practice Address - Street 1:777 PARK AVE W
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-570-2714
Practice Address - Fax:847-570-1436
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011954363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1154726214Medicaid