Healthcare Provider Details

I. General information

NPI: 1265542534
Provider Name (Legal Business Name): AMY A PICOLO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 OLENTANGY RIVER RD STE 220
COLUMBUS OH
43214-3907
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4924
  • Fax: 614-566-6636
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.18113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: