Healthcare Provider Details

I. General information

NPI: 1497278766
Provider Name (Legal Business Name): CAROLINA BARBA-WILLIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE UNIT M60
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

3253 BURNHAM DR
BRUNSWICK OH
44212-1376
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 330-242-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: