=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134501877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLI J KOVACH ROMERO NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2015
-----------------------------------------------------
Last Update Date | 09/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7345 STATE ROUTE 3
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-8654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-794-5560
-----------------------------------------------------
Fax | 614-839-0274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14121 PARKE LONG COURT, SUITE 201
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-247-1940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.17465
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------