Jenna K Dolak, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0035643 Issued in OH

Practice address

250 Debartolo PL Ste B
Youngstown, OH 44512-7004

Phone

(234) 375-0659

Fax

(330) 758-3282

NPI assigned

Jan 19, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Jenna K Gibson Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352
• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Triad Health Services, LLC

  • Plastic Surgery Physician
  • Youngstown, OH
  • NPI 1588925457

  Family

  Medicare reassignment Care Compare group NPD
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1710748439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DEBARTOLO PL STE 200",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445126095",
            "telephone_number": "234-375-0659",
            "fax_number": "330-758-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 DEBARTOLO PL STE B",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445127004",
            "telephone_number": "234-375-0659",
            "fax_number": "330-758-3282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 S Water St",
            "address_purpose": "LOCATION",
            "city": "Kent",
            "state": "OH",
            "postal_code": "442403548",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLAK",
        "first_name": "JENNA",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-19",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0035643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0040434",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "GIBSON",
            "middle_name": "K",
            "prefix": "MS.",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Autumn Nicole Dodson, INDEPENDENT PROVIDER
• Jasmine Dodson
• Shade Dodson
• Nathaniel S Doe, M.D.
• Nicole Lynn Dohar, SLP
• Laura Lynn Dollison, DO
• Ann Dombroski, DO
• James William Dombroski, MD
• Valerie Domitrovich
• Jade M Domos, CDCA-PRE

• Family Nurse Practitioner in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.