MEDICARE: MS. LATISHA JANINE CARROLL R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	173320	OH
2	163WC1600X	Continuing Education/Staff Development Registered Nurse	RN357419	OH
3	163WH0200X	Home Health Registered Nurse	RN357419	OH
4	163WM1400X	Nurse Massage Therapist (NMT)	RN357419	OH
5	174H00000X	Health Educator
6	225700000X	Massage Therapist
7	225700000X	Massage Therapist	33.025302	OH
8	163W00000X	Registered Nurse	RN357419	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023245362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATISHA JANINE CARROLL R.N.

Provider Business Mailing Address
First Line	:	1391 W 5TH AVE # 241
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2902
Country	:	US
Telephone Number	:	614-935-4785
Fax Number	:	614-413-3956

Provider Business Practice Location Address
First Line	:	655 N CASSADY AVE STE 7
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2720
Country	:	US
Telephone Number	:	614-843-4013
Fax Number	:	614-413-3956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2009
Last Update Date	:	03/08/2026

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Directions to “ MS. LATISHA JANINE CARROLL R.N.” Practice Location

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