Healthcare Provider Details

I. General information

NPI: 1053791293
Provider Name (Legal Business Name): CARLY ELIZABETH NICHOLAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CARLY ELIZABETH GARMAN

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 BEECHMONT AVE STE N
CINCINNATI OH
45255-4231
US

IV. Provider business mailing address

7545 BEECHMONT AVE STE N
CINCINNATI OH
45255-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-0011
  • Fax: 513-232-8434
Mailing address:
  • Phone: 513-232-0011
  • Fax: 513-232-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP17660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: