Provider Demographics
NPI:1851148225
Name:GAINES, JAZZ NICOLE (STNA)
Entity type:Individual
Prefix:
First Name:JAZZ
Middle Name:NICOLE
Last Name:GAINES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 WALTELLA PL APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1647
Mailing Address - Country:US
Mailing Address - Phone:513-836-9368
Mailing Address - Fax:
Practice Address - Street 1:5350 WALTELLA PL APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1647
Practice Address - Country:US
Practice Address - Phone:513-836-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602388180921376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide