Healthcare Provider Details

I. General information

NPI: 1235094830
Provider Name (Legal Business Name): CAROLINA OLIVEIRA FORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40-44 ROME ST APT 4
NEWARK NJ
07105-3350
US

IV. Provider business mailing address

40-44 ROME ST APT 4
NEWARK NJ
07105-3350
US

V. Phone/Fax

Practice location:
  • Phone: 973-449-1504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15484500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: