Provider Demographics
NPI:1285148882
Name:SMITH, JENNINGS (AGACNP-BC,RN, MSN)
Entity type:Individual
Prefix:
First Name:JENNINGS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:AGACNP-BC,RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:STE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1918
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:3909 WOODLEY RD STE 600
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1179
Practice Address - Country:US
Practice Address - Phone:419-291-4590
Practice Address - Fax:419-291-4593
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.373538163W00000X
OH022331363LG0600X
IL209022731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology