MEDICARE: LAQUISHA CARROLL ARNP

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	363LF0000X	Family Nurse Practitioner	025455	OH
2	363LF0000X	Family Nurse Practitioner	209013461	IL
3	363LF0000X	Family Nurse Practitioner	AP61037335	WA

General Provider Information

NPI Number	:	1750746152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUISHA CARROLL ARNP

Provider Business Mailing Address
First Line	:	3115 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2429
Country	:	US
Telephone Number	:	216-332-7891
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	04/09/2024

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