Individual
JACQUELINE M TRICOMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2783-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221188
UNISON
OH
01
—
000000374507
ANTHEM
OH
01
—
000000526068
ANTHEM
OH
05
—
2348598
—
OH
01
—
363693
WELLCARE
OH
01
—
7423723
AETNA
OH
01
—
745927
BUCKEYE
OH
Enumeration date
07/24/2006
Last updated
08/18/2011
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