Healthcare Provider Details

I. General information

NPI: 1851199269
Provider Name (Legal Business Name): ALEXA GOLLOH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 NEIL AVE
COLUMBUS OH
43201-2320
US

IV. Provider business mailing address

1577 NEIL AVE
COLUMBUS OH
43201-2320
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4041
  • Fax:
Mailing address:
  • Phone: 614-292-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0039341
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0039341
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.531767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: