Healthcare Provider Details

I. General information

NPI: 1821323569
Provider Name (Legal Business Name): NAFISA IBRAHIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 BROAD ST SW
PATASKALA OH
43062-7886
US

IV. Provider business mailing address

2491 GRIFFIN GATE LN UNIT 201
COLUMBUS OH
43219-3919
US

V. Phone/Fax

Practice location:
  • Phone: 740-927-6705
  • Fax: 740-964-0036
Mailing address:
  • Phone: 614-209-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024746
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN. 353502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: