Individual
MR. JOHN GERARD IDZAKOVICH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NNP
Contact information
Practice address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 722-4560
(614) 722-4541
Mailing address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 722-2000
(614) 722-4541
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.0029344
OH
363LN0000X
Neonatal Nurse Practitioner
Primary
APRN.CNP.0029344
OH
363LN0005X
Critical Care Neonatal Nurse Practitioner
APRN.CNP.0029344
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0452703
—
OH
Enumeration date
05/24/2021
Last updated
12/29/2025
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