Provider Demographics
NPI:1003528100
Name:ELLIOTT, CARLA JEAN (HHA)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JEAN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 E MOLER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1334
Mailing Address - Country:US
Mailing Address - Phone:614-588-2200
Mailing Address - Fax:614-754-8024
Practice Address - Street 1:597 E MOLER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1334
Practice Address - Country:US
Practice Address - Phone:614-588-2200
Practice Address - Fax:614-754-8024
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide