Healthcare Provider Details

I. General information

NPI: 1558867770
Provider Name (Legal Business Name): CARLI JO MIDDLETON FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ASHLAND AVE
TOLEDO OH
43620-1703
US

IV. Provider business mailing address

2005 ASHLAND AVE
TOLEDO OH
43620-1703
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-7701
  • Fax:
Mailing address:
  • Phone: 419-841-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023263
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.023263
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number427865
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: