Healthcare Provider Details

I. General information

NPI: 1861947467
Provider Name (Legal Business Name): ASHLEY CARUNCHIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 04/09/2024
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

704 OBIER CT
MIDDLETOWN DE
19709-2608
US

V. Phone/Fax

Practice location:
  • Phone: 877-581-2210
  • Fax: 614-968-8840
Mailing address:
  • Phone: 609-947-5618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-000919
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: